Healthcare Provider Details

I. General information

NPI: 1528836475
Provider Name (Legal Business Name): ANGELIQUE HOWARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SPRUCE ST STE 250
RIVERSIDE CA
92507-7429
US

IV. Provider business mailing address

1650 SPRUCE ST STE 250
RIVERSIDE CA
92507-7429
US

V. Phone/Fax

Practice location:
  • Phone: 909-304-1039
  • Fax: 760-634-1125
Mailing address:
  • Phone: 909-304-1039
  • Fax: 760-634-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: