Healthcare Provider Details

I. General information

NPI: 1922584408
Provider Name (Legal Business Name): ANGIE BOZEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15110 CALIFORNIA AVE
PARAMOUNT CA
90723
US

IV. Provider business mailing address

15123 MAIDSTONE AVE
NORWALK CA
90650
US

V. Phone/Fax

Practice location:
  • Phone: 562-602-6000
  • Fax:
Mailing address:
  • Phone: 424-285-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number31761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: