Healthcare Provider Details

I. General information

NPI: 1689535486
Provider Name (Legal Business Name): MRS. ANGELINE AMY SWAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELINE AMY TRIEU

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date: 02/28/2026
Reactivation Date: 08/11/2026

III. Provider practice location address

1225 W 190TH ST STE 280
GARDENA CA
90248-4305
US

IV. Provider business mailing address

1225 W 190TH ST STE 280
GARDENA CA
90248-4305
US

V. Phone/Fax

Practice location:
  • Phone: 877-515-8113
  • Fax: 877-538-2102
Mailing address:
  • Phone: 877-515-8113
  • Fax: 877-538-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: