Healthcare Provider Details

I. General information

NPI: 1740559665
Provider Name (Legal Business Name): ANGELA IRVING KIRKMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18302 IRVINE BLVD SUITE 300
TUSTIN CA
92780-3435
US

IV. Provider business mailing address

18302 IRVINE BLVD SUITE 300
TUSTIN CA
92780-3435
US

V. Phone/Fax

Practice location:
  • Phone: 714-957-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW 23800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: