Healthcare Provider Details

I. General information

NPI: 1770139487
Provider Name (Legal Business Name): ANGELIAN MANAGEMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2019
Last Update Date: 08/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23551 MOULTON PKWY
LAGUNA HILLS CA
92653-1911
US

IV. Provider business mailing address

23551 MOULTON PKWY
LAGUNA HILLS CA
92653-1911
US

V. Phone/Fax

Practice location:
  • Phone: 949-707-1707
  • Fax: 949-258-5117
Mailing address:
  • Phone: 949-707-1707
  • Fax: 949-258-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONA YACKO
Title or Position: ADMINISTRATOR
Credential:
Phone: 949-933-6546