Healthcare Provider Details

I. General information

NPI: 1154100683
Provider Name (Legal Business Name): ANGELA OGANEZOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8152 COLDWATER CANYON AVE
NORTH HOLLYWOOD CA
91605-1128
US

IV. Provider business mailing address

14553 DELANO ST STE 314
VAN NUYS CA
91411-2897
US

V. Phone/Fax

Practice location:
  • Phone: 818-293-8280
  • Fax:
Mailing address:
  • Phone: 818-293-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number781439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: