Healthcare Provider Details

I. General information

NPI: 1679971972
Provider Name (Legal Business Name): ANGELA NURISTANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33363 WALLACE WAY
YUCAIPA CA
92399-3471
US

IV. Provider business mailing address

33363 WALLACE WAY
YUCAIPA CA
92399-3471
US

V. Phone/Fax

Practice location:
  • Phone: 619-808-1123
  • Fax: 909-918-0063
Mailing address:
  • Phone: 619-808-1123
  • Fax: 909-918-0063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: