Healthcare Provider Details

I. General information

NPI: 1386195105
Provider Name (Legal Business Name): MA ANGELICA CUYUGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 S BRISTOL ST SUITE 202
SANTA ANA CA
92704-5766
US

IV. Provider business mailing address

2621 S BRISTOL ST SUITE 202
SANTA ANA CA
92704-5766
US

V. Phone/Fax

Practice location:
  • Phone: 657-900-4536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: