Active NPI
Keane Evangelista
- Physical Therapist
- La Mesa, CA
National Provider Identifier
1265130728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 5696 Lake Murray Blvd
La Mesa, CA 91942-1929 - Phone
- (619) 460-7871
- NPI assigned
- Feb 23, 2023
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
5696 Lake Murray Blvd
La Mesa, CA 91942-1929
Mailing address
7548 Charmant Dr Apt 1411
San Diego, CA 92122-5050
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": "1677110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677110400000",
"number": "1265130728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7548 CHARMANT DR APT 1411",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921225050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5696 LAKE MURRAY BLVD",
"city": "LA MESA",
"state": "CA",
"postal_code": "919421929",
"telephone_number": "619-460-7871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANGELISTA",
"first_name": "KEANE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-02-23",
"last_updated": "2023-02-23",
"certification_date": "2023-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.