Healthcare Provider Details

I. General information

NPI: 1609334580
Provider Name (Legal Business Name): ANGEL MCCURN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2019
Last Update Date: 03/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 W SHAW AVE
FRESNO CA
93711-3516
US

IV. Provider business mailing address

21600 OXNARD ST
WOODLAND HILLS CA
91367-4976
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-5900
  • Fax:
Mailing address:
  • Phone: 818-345-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberF3221131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: