Healthcare Provider Details

I. General information

NPI: 1366796740
Provider Name (Legal Business Name): ANDREA A. ANGSTADT SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 6TH AVE SUITE 103
SAN DIEGO CA
92103-4383
US

IV. Provider business mailing address

3731 6TH AVE SUITE 103
SAN DIEGO CA
92103-4383
US

V. Phone/Fax

Practice location:
  • Phone: 619-291-3515
  • Fax: 619-291-3529
Mailing address:
  • Phone: 619-291-3515
  • Fax: 619-291-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSPA 1563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: