Healthcare Provider Details

I. General information

NPI: 1386290401
Provider Name (Legal Business Name): ANGELA DENISE BIVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12917 CERISE AVE
HAWTHORNE CA
90250-5520
US

IV. Provider business mailing address

12917 CERISE AVE
HAWTHORNE CA
90250-5520
US

V. Phone/Fax

Practice location:
  • Phone: 310-675-4431
  • Fax: 310-679-2920
Mailing address:
  • Phone: 310-675-4431
  • Fax: 310-679-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII054100418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: