Healthcare Provider Details

I. General information

NPI: 1295458040
Provider Name (Legal Business Name): ANGELA SOVATHA DAO MSW, MPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26569 COMMUNITY CENTER DR
HIGHLAND CA
92346-6712
US

IV. Provider business mailing address

26569 COMMUNITY CENTER DR
HIGHLAND CA
92346-6712
US

V. Phone/Fax

Practice location:
  • Phone: 909-936-8648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number110528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: