Healthcare Provider Details

I. General information

NPI: 1851116404
Provider Name (Legal Business Name): ANGELINA JASMINE NARCISO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELINA NARCISO

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 KAUSEN DR STE 104
ELK GROVE CA
95758-7178
US

IV. Provider business mailing address

501 SHATTO PL STE 100
LOS ANGELES CA
90020-1747
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-3223
  • Fax: 323-866-1881
Mailing address:
  • Phone: 888-428-3223
  • Fax: 323-866-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: