Healthcare Provider Details

I. General information

NPI: 1972930592
Provider Name (Legal Business Name): ANGELA LUCIA VENEGAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

3701 WILSHIRE BLVD STE 600
LOS ANGELES CA
90010-2814
US

V. Phone/Fax

Practice location:
  • Phone: 886-312-4528
  • Fax: 323-361-8988
Mailing address:
  • Phone: 888-631-2452
  • Fax: 323-361-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA156458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: