Healthcare Provider Details

I. General information

NPI: 1174276455
Provider Name (Legal Business Name): ANGEL INIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 OXNARD ST
WOODLAND HILLS CA
91367-4976
US

IV. Provider business mailing address

21600 OXNARD STREET, SUITE 1030
WOODLAND HILLS CA
91367-5409
US

V. Phone/Fax

Practice location:
  • Phone: 877-206-1009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: