Healthcare Provider Details

I. General information

NPI: 1578841946
Provider Name (Legal Business Name): THERESA ANNE CANGIALOSI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 WORSHAM AVE STE 301
LONG BEACH CA
90808-1766
US

IV. Provider business mailing address

918 EMERALD ST
REDONDO BEACH CA
90277-3261
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-5479
  • Fax: 562-988-7616
Mailing address:
  • Phone: 310-697-6833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: