Healthcare Provider Details

I. General information

NPI: 1699210500
Provider Name (Legal Business Name): ANGELA CASH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2016
Last Update Date: 12/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 S ROBERTSON BLVD STE 242
LOS ANGELES CA
90035-1403
US

IV. Provider business mailing address

1417 E KRAMER DR
CARSON CA
90746-2667
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-4321
  • Fax:
Mailing address:
  • Phone: 808-494-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95005763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: