Healthcare Provider Details

I. General information

NPI: 1962997361
Provider Name (Legal Business Name): MARIA CRISTINA ANG-RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 SWIFT FOX CT
SIMI VALLEY CA
93065-0245
US

IV. Provider business mailing address

2239 SWIFT FOX CT
SIMI VALLEY CA
93065-0245
US

V. Phone/Fax

Practice location:
  • Phone: 310-308-9934
  • Fax:
Mailing address:
  • Phone: 310-308-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95008763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: