Healthcare Provider Details

I. General information

NPI: 1548863467
Provider Name (Legal Business Name): ANGIE BIMAT RDH, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9506 CATTARAUGUS AVE
LOS ANGELES CA
90034-2322
US

IV. Provider business mailing address

9506 CATTARAUGUS AVE
LOS ANGELES CA
90034-2322
US

V. Phone/Fax

Practice location:
  • Phone: 310-801-4413
  • Fax:
Mailing address:
  • Phone: 310-801-4413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberL-308322
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH17231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: