Healthcare Provider Details

I. General information

NPI: 1760311146
Provider Name (Legal Business Name): ANGELA DAWN COLLINS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 MACIEL LN
CRESCENT CITY CA
95531-8633
US

IV. Provider business mailing address

PO BOX 1044
CRESCENT CITY CA
95531-1044
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-9578
  • Fax:
Mailing address:
  • Phone: 707-464-9578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: