Healthcare Provider Details

I. General information

NPI: 1285439075
Provider Name (Legal Business Name): AMERICAN ANGELS HEALTH & CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 E LEXINGTON AVE # 105
EL CAJON CA
92020-4520
US

IV. Provider business mailing address

1013 ACERO ST
CHULA VISTA CA
91910-8018
US

V. Phone/Fax

Practice location:
  • Phone: 619-901-9100
  • Fax:
Mailing address:
  • Phone: 619-901-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TUBA KAZAN IBRAHIM
Title or Position: CEO
Credential:
Phone: 619-901-9100