Healthcare Provider Details

I. General information

NPI: 1730434473
Provider Name (Legal Business Name): ANABELLE MANGLONA LLANA BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 MISSION GORGE RD 108
SAN DIEGO CA
92120-3410
US

IV. Provider business mailing address

8003 WINTER GARDENS BLVD APT 210
EL CAJON CA
92021-1485
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-2363
  • Fax: 619-682-4037
Mailing address:
  • Phone: 619-528-2363
  • Fax: 619-682-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: