Healthcare Provider Details

I. General information

NPI: 1710890868
Provider Name (Legal Business Name): ANGELA MARIE CALLEJA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W WASHINGTON BLVD
CRESCENT CITY CA
95531-8340
US

IV. Provider business mailing address

1735 CAROLE LN
CRESCENT CITY CA
95531-8813
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-6141
  • Fax:
Mailing address:
  • Phone: 707-954-4998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number3294443879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: