Healthcare Provider Details

I. General information

NPI: 1346151149
Provider Name (Legal Business Name): ANGELICA KOTSONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8831 VENICE BLVD
LOS ANGELES CA
90034-3223
US

IV. Provider business mailing address

8831 VENICE BLVD
LOS ANGELES CA
90034-3223
US

V. Phone/Fax

Practice location:
  • Phone: 310-204-5200
  • Fax:
Mailing address:
  • Phone: 310-280-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: