Healthcare Provider Details

I. General information

NPI: 1356524441
Provider Name (Legal Business Name): ANGELA ADAMS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5465 HILLCREST DR
LOS ANGELES CA
90043-2322
US

IV. Provider business mailing address

5465 HILLCREST DR
LOS ANGELES CA
90043-2322
US

V. Phone/Fax

Practice location:
  • Phone: 310-213-4628
  • Fax:
Mailing address:
  • Phone: 310-213-4628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number694199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: