Healthcare Provider Details

I. General information

NPI: 1871201244
Provider Name (Legal Business Name): ANGELLA BRINKMAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGIE BRINKMAN MA

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23509 CANTARA RD
CORONA CA
92883-9230
US

IV. Provider business mailing address

23509 CANTARA RD
CORONA CA
92883-9230
US

V. Phone/Fax

Practice location:
  • Phone: 949-202-6112
  • Fax:
Mailing address:
  • Phone: 949-202-6112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number133946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: