Healthcare Provider Details

I. General information

NPI: 1790117323
Provider Name (Legal Business Name): ANGELIKA NUGENT LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1258A ARMISTEAD RD
SAN FRANCISCO CA
94129-4000
US

IV. Provider business mailing address

1258A ARMISTEAD RD
SAN FRANCISCO CA
94129-4000
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-4057
  • Fax: 415-885-4057
Mailing address:
  • Phone: 415-885-4057
  • Fax: 415-885-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number88
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: