Healthcare Provider Details

I. General information

NPI: 1417903931
Provider Name (Legal Business Name): FELIZA ANGELINE CALUB NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD MAIL CODE 117
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

11301 WILSHIRE BLVD MAIL CODE 117
LOS ANGELES CA
90073-1003
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax: 310-268-4935
Mailing address:
  • Phone: 310-478-3711
  • Fax: 310-268-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: