Healthcare Provider Details

I. General information

NPI: 1336504448
Provider Name (Legal Business Name): ANGELA HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST #400
GARDENA CA
90248-4223
US

IV. Provider business mailing address

879 W 190TH ST #400
GARDENA CA
90248-4223
US

V. Phone/Fax

Practice location:
  • Phone: 310-217-4024
  • Fax: 310-329-1729
Mailing address:
  • Phone: 310-217-4024
  • Fax: 310-329-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number2792312-0001-5
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: