Healthcare Provider Details

I. General information

NPI: 1164353181
Provider Name (Legal Business Name): ANGELICA KHOLINE ENCARNADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 FAIRMONT DR BUILDING B
SAN LEANDRO CA
94578
US

IV. Provider business mailing address

2050 FAIRMONT DR BUILDING B
SAN LEANDRO CA
94578
US

V. Phone/Fax

Practice location:
  • Phone: 510-483-3030
  • Fax:
Mailing address:
  • Phone: 510-483-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: