Healthcare Provider Details

I. General information

NPI: 1912372921
Provider Name (Legal Business Name): ANGELINA FIGUEROA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 S DORA ST STE D
UKIAH CA
95482-5465
US

IV. Provider business mailing address

564 S DORA ST STE D
UKIAH CA
95482-5465
US

V. Phone/Fax

Practice location:
  • Phone: 707-472-0362
  • Fax: 707-472-0121
Mailing address:
  • Phone: 707-472-0362
  • Fax: 707-472-0121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number259782
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: