Healthcare Provider Details

I. General information

NPI: 1154746121
Provider Name (Legal Business Name): ANGELA WEST DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3718 GRAND AVE STE 15
OAKLAND CA
94610-1544
US

IV. Provider business mailing address

19301 CENTER ST
CASTRO VALLEY CA
94546-3620
US

V. Phone/Fax

Practice location:
  • Phone: 510-893-8878
  • Fax:
Mailing address:
  • Phone: 510-329-4846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number41494
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305208539
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: