Healthcare Provider Details

I. General information

NPI: 1326968611
Provider Name (Legal Business Name): MRS. ERIKA DANAE ANGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ERIKA DANAE BULTHUIS

II. Dates (important events)

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

III. Provider practice location address

2655 CAMINO DEL RIO N. SUITE 450 SUITE 450
SAN DIEGO CA
92108
US

IV. Provider business mailing address

2655 CAMINO DEL RIO N. SUITE 450
SAN DIEGO CA
92108
US

V. Phone/Fax

Practice location:
  • Phone: 619-633-4115
  • Fax:
Mailing address:
  • Phone: 619-633-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number373H00000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: