Provider Demographics
NPI:1154480887
Name:EVANGELISTA, ALLAN (DPM, MPH)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:EVANGELISTA
Suffix:
Gender:M
Credentials:DPM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NEW STINE RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2605
Mailing Address - Country:US
Mailing Address - Phone:661-832-1667
Mailing Address - Fax:208-719-0085
Practice Address - Street 1:110 NEW STINE RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2605
Practice Address - Country:US
Practice Address - Phone:661-832-1667
Practice Address - Fax:661-832-7145
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5423213ES0103X
FLPO4022213ES0103X
OH36.003534213ES0103X
PASC005582213ES0103X
WV10442213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2834099Medicaid
2018774OtherBLUE SHIELD
1007775620010OtherPA MA GROUP
2022587OtherBS GROUP FOR PODIATRY
412213OtherUPMC
P00658026OtherMC RR
PA1020943590001Medicaid
812105OtherHEALTH AMERICA
812105OtherHEALTH AMERICA
2022587OtherBS GROUP FOR PODIATRY
PA1020943590001Medicaid
812105OtherHEALTH AMERICA