Individual
EVARISTUS PENDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1105 SW 30TH CT, MOORE, OK 73160-2887
(405) 676-5114
Mailing address
9500 SW 33RD ST, OKLAHOMA CITY, OK 73179-1212
(405) 408-4073
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
10061
OK
171M00000X
Case Manager/Care Coordinator
—
—
372600000X
Adult Companion
—
—
376K00000X
Nurse's Aide
—
—
Other
Enumeration date
08/06/2015
Last updated
12/12/2025
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