MEDICARE: ANGIE BIMAT RDH, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	RDH17231	CA
2	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1548863467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGIE BIMAT RDH, IBCLC

Provider Business Mailing Address
First Line	:	9506 CATTARAUGUS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-2322
Country	:	US
Telephone Number	:	310-801-4413
Fax Number	:

Provider Business Practice Location Address
First Line	:	9506 CATTARAUGUS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-2322
Country	:	US
Telephone Number	:	310-801-4413
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2020
Last Update Date	:	06/20/2025

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