Provider Demographics
NPI:1821299405
Name:EVANGUELIDI, ALEKSANDRA KRISTIN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:KRISTIN
Last Name:EVANGUELIDI
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11965 VENICE BLVD
Mailing Address - Street 2:SUITE# 307
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3979
Mailing Address - Country:US
Mailing Address - Phone:310-493-9134
Mailing Address - Fax:310-566-7699
Practice Address - Street 1:11965 VENICE BLVD
Practice Address - Street 2:SUITE# 307
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3979
Practice Address - Country:US
Practice Address - Phone:310-566-7690
Practice Address - Fax:310-566-7699
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM201176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife