Provider Demographics
NPI:1821271768
Name:EVANGELISTA, CINDY C (PA-C)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:C
Last Name:EVANGELISTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:EVANGELISTA-DE LEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:837 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2628
Mailing Address - Country:US
Mailing Address - Phone:626-398-6300
Mailing Address - Fax:626-204-0086
Practice Address - Street 1:1855 N FAIR OAKS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1620
Practice Address - Country:US
Practice Address - Phone:626-398-6300
Practice Address - Fax:626-204-0086
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871689315Medicaid