Healthcare Provider Details

I. General information

NPI: 1689557498
Provider Name (Legal Business Name): ANGELINE AMANGO PAYANGDO-ALICAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE RD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

3425 WILL SCARLET WAY
MODESTO CA
95355-9299
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-4500
  • Fax:
Mailing address:
  • Phone: 209-501-5514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN95289946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: