Healthcare Provider Details

I. General information

NPI: 1245161629
Provider Name (Legal Business Name): ANGELA RAE MADDOCK DACM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4263 STERLING VIEW DR
FALLBROOK CA
92028-9664
US

IV. Provider business mailing address

4257 STERLING VIEW DR
FALLBROOK CA
92028-9664
US

V. Phone/Fax

Practice location:
  • Phone: 760-310-8315
  • Fax:
Mailing address:
  • Phone: 760-310-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number62818
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: