Healthcare Provider Details

I. General information

NPI: 1952182248
Provider Name (Legal Business Name): ANGELICA RUTH BRIGHTMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 W 47TH PL
LOS ANGELES CA
90037-3234
US

IV. Provider business mailing address

941 SOUTH VERMONT AVENUE STE 101 #238
LOS ANGELES CA
90006
US

V. Phone/Fax

Practice location:
  • Phone: 213-282-0901
  • Fax:
Mailing address:
  • Phone: 213-282-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: