Healthcare Provider Details

I. General information

NPI: 1235567538
Provider Name (Legal Business Name): ANGELA COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 BROOKSHIRE AVE
DOWNEY CA
90241-4917
US

IV. Provider business mailing address

11500 BROOKSHIRE AVE
DOWNEY CA
90241-4917
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-5000
  • Fax:
Mailing address:
  • Phone: 562-904-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: