Jonathan Evanculla, is a
Counselor - Mental Health based in Los Angeles, California. Jonathan Evanculla is licensed to practice in California (license number 103106) and his current practice location is
4211 Avalon Blvd, Los Angeles, California. He can be reached at his office (for appointments etc.) via phone at
(323) 233-0425.
NPI number for Jonathan Evanculla is 1740840214 and his current mailing address is 4211 Avalon Blvd, Los Angeles, California. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1740840214.
Healthcare Provider's Profile
| Full Name | Jonathan Evanculla |
|---|
| Gender | Male |
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| Speciality | Counselor - Mental Health |
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| Location | 4211 Avalon Blvd, Los Angeles, California |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1740840214
- Provider Enumeration Date: 06/17/2019
- Last Update Date: 08/25/2021
Medical Identifiers
Medical identifiers for Jonathan Evanculla such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1740840214 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1041C0700X | Social Worker - Clinical | 103106 (California) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | 103106 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jonathan Evanculla is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jonathan Evanculla,
4211 Avalon Blvd,
Los Angeles, CA 90011-5622
Ph: (323) 233-0425 | Jonathan Evanculla,
4211 Avalon Blvd,
Los Angeles, CA 90011-5622
Ph: (323) 233-0425 |
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