Healthcare Provider Details

I. General information

NPI: 1720909153
Provider Name (Legal Business Name): HOPE ANGELIQUE BODAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 W 10TH ST
CORONA CA
92882-3901
US

IV. Provider business mailing address

1870 W ASH ST
SAN BERNARDINO CA
92407-2362
US

V. Phone/Fax

Practice location:
  • Phone: 951-736-3211
  • Fax:
Mailing address:
  • Phone: 208-819-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: