Provider Demographics
NPI:1235844580
Name:EVANGELISTA, CHRISTIAN NOEL I (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN NOEL
Middle Name:I
Last Name:EVANGELISTA
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2399 MARYHELEN ST APT 101
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7733
Mailing Address - Country:US
Mailing Address - Phone:951-824-0026
Mailing Address - Fax:
Practice Address - Street 1:560 S PASEO DOROTEA STE 4A
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1434
Practice Address - Country:US
Practice Address - Phone:951-297-8375
Practice Address - Fax:951-602-8264
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95022586363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health