Provider Demographics
NPI:1982723706
Name:LEON-TORRES, EVANGELINE DEOMAMPO (MPH, CHES)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:DEOMAMPO
Last Name:LEON-TORRES
Suffix:
Gender:F
Credentials:MPH, CHES
Other - Prefix:
Other - First Name:EVANGELINE
Other - Middle Name:MONTERO
Other - Last Name:DEOMAMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, CHES
Mailing Address - Street 1:1729 VALLEY BEND ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1766
Mailing Address - Country:US
Mailing Address - Phone:619-656-0528
Mailing Address - Fax:619-656-0528
Practice Address - Street 1:3851 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8023
Practice Address - Fax:619-692-8827
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HICHES#5648174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist