Healthcare Provider Details

I. General information

NPI: 1629476429
Provider Name (Legal Business Name): ANGELIC HEALTH CARE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1286 UNIVERSITY AVE STE 579
SAN DIEGO CA
92103-3312
US

IV. Provider business mailing address

350 10TH AVE STE 1000
SAN DIEGO CA
92101-8705
US

V. Phone/Fax

Practice location:
  • Phone: 619-342-9400
  • Fax:
Mailing address:
  • Phone: 619-342-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MISS SHIRINE BAKER
Title or Position: CHIEF NURSING OFFICER
Credential: RN
Phone: 619-342-9400