Healthcare Provider Details

I. General information

NPI: 1891391686
Provider Name (Legal Business Name): ANGELINE VIBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 WOODLAWN AVE
VENICE CA
90291-4853
US

IV. Provider business mailing address

716 WOODLAWN AVE
VENICE CA
90291-4853
US

V. Phone/Fax

Practice location:
  • Phone: 626-715-5429
  • Fax:
Mailing address:
  • Phone: 626-715-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: