Healthcare Provider Details

I. General information

NPI: 1104544865
Provider Name (Legal Business Name): ANGELINA STAHLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44480 20TH ST W
LANCASTER CA
93534-2714
US

IV. Provider business mailing address

44480 20TH ST W
LANCASTER CA
93534-2714
US

V. Phone/Fax

Practice location:
  • Phone: 661-723-3414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: