Healthcare Provider Details

I. General information

NPI: 1194754457
Provider Name (Legal Business Name): ANGELA NOSSETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 S FETTERLY AVE RM 2284
LOS ANGELES CA
90022-1605
US

IV. Provider business mailing address

245 S FETTERLY AVE RM 2284
LOS ANGELES CA
90022-1605
US

V. Phone/Fax

Practice location:
  • Phone: 332-780-2205
  • Fax: 323-264-3771
Mailing address:
  • Phone: 332-780-2205
  • Fax: 323-264-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA071543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: