Healthcare Provider Details

I. General information

NPI: 1770326399
Provider Name (Legal Business Name): ANGELA WORSHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/13/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 ALVA ST
CARPINTERIA CA
93013-1501
US

IV. Provider business mailing address

3067 HARBOR BLVD
VENTURA CA
93001-4211
US

V. Phone/Fax

Practice location:
  • Phone: 805-566-0299
  • Fax:
Mailing address:
  • Phone: 915-383-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: