Healthcare Provider Details

I. General information

NPI: 1336239409
Provider Name (Legal Business Name): ANGIE MIKHAIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18102 CULVER DR
IRVINE CA
92612-2730
US

IV. Provider business mailing address

18102 CULVER DR
IRVINE CA
92612-2730
US

V. Phone/Fax

Practice location:
  • Phone: 657-241-8220
  • Fax: 949-407-5278
Mailing address:
  • Phone: 657-241-8220
  • Fax: 949-407-5278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number585048
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00157444
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP15099
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15099
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30006992
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: