Active NPI
Evangelia Ly
- Community Health Worker
- Pacoima, CA
National Provider Identifier
1104671031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331-1393 - Phone
- (818) 896-1161
- NPI assigned
- Apr 23, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | CA | Primary |
Addresses
Primary practice location
12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331-1393
Mailing address
12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331-1393
Phone (818) 896-1161
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7420 | Medicaid | CA | |
| 7068 | Medicaid | CA | |
| 6758 | Medicaid | CA | |
| 1954 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713830400000",
"number": "1104671031",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12450 VAN NUYS BLVD STE 200",
"city": "PACOIMA",
"state": "CA",
"postal_code": "913311393",
"telephone_number": "818-896-1161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12450 VAN NUYS BLVD STE 200",
"city": "PACOIMA",
"state": "CA",
"postal_code": "913311393",
"telephone_number": "818-896-1161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "EVANGELIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-04-23",
"last_updated": "2024-04-23",
"certification_date": "2024-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7420",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7068",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6758",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1954",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pacoima, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.