Healthcare Provider Details

I. General information

NPI: 1578496899
Provider Name (Legal Business Name): ANGELA EMILY BURDICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45000 MAIN STREET UNIT D
MENDOCINO CA
95460
US

IV. Provider business mailing address

PO BOX 1215
MENDOCINO CA
95460-1215
US

V. Phone/Fax

Practice location:
  • Phone: 707-357-6879
  • Fax:
Mailing address:
  • Phone: 707-357-6879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number84456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: