Provider Demographics
NPI:1518142546
Name:EVANGELISTA, JEMYLENE RONSAYRO (MD)
Entity Type:Individual
Prefix:DR
First Name:JEMYLENE
Middle Name:RONSAYRO
Last Name:EVANGELISTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2435 S AVENUE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7175
Mailing Address - Country:US
Mailing Address - Phone:928-726-6772
Mailing Address - Fax:928-726-3012
Practice Address - Street 1:2435 S AVENUE A STE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7176
Practice Address - Country:US
Practice Address - Phone:928-726-6772
Practice Address - Fax:928-726-3012
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ42252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine