Provider Demographics
NPI:1942087119
Name:EVOLVE PSYCHIATRY AND WELLNESS A NURSING CORPORATION
Entity Type:Organization
Organization Name:EVOLVE PSYCHIATRY AND WELLNESS A NURSING CORPORATION
Other - Org Name:EVOLVE PSYCHIATRY AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHOMYA
Authorized Official - Middle Name:
Authorized Official - Last Name:OO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-699-2125
Mailing Address - Street 1:1508 BARTON RD STE 216
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1410
Mailing Address - Country:US
Mailing Address - Phone:909-895-0546
Mailing Address - Fax:909-935-1185
Practice Address - Street 1:1508 BARTON RD
Practice Address - Street 2:STE 216
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-1410
Practice Address - Country:US
Practice Address - Phone:909-895-0546
Practice Address - Fax:909-935-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty