Healthcare Provider Details

I. General information

NPI: 1629996459
Provider Name (Legal Business Name): ANGELLA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 HUNTINGTON DR STE 203
SOUTH PASADENA CA
91030-4860
US

IV. Provider business mailing address

1730 HUNTINGTON DR STE 203
SOUTH PASADENA CA
91030-4860
US

V. Phone/Fax

Practice location:
  • Phone: 909-287-6172
  • Fax:
Mailing address:
  • Phone: 909-287-6172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: