Healthcare Provider Details

I. General information

NPI: 1205394459
Provider Name (Legal Business Name): ANGELA NICOLE MECKLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E MAIN ST
SANTA PAULA CA
93060-2748
US

IV. Provider business mailing address

8945 GOLF LINKS RD
OAKLAND CA
94605-4124
US

V. Phone/Fax

Practice location:
  • Phone: 805-525-1618
  • Fax:
Mailing address:
  • Phone: 510-317-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number95179529
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95027510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: