Healthcare Provider Details

I. General information

NPI: 1265308423
Provider Name (Legal Business Name): ANGELIA MOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 JACKSON ST BLDG L
ALEXANDRIA LA
71303-2326
US

IV. Provider business mailing address

5615 JACKSON ST BLDG L
ALEXANDRIA LA
71303-2326
US

V. Phone/Fax

Practice location:
  • Phone: 318-448-1801
  • Fax: 318-448-1841
Mailing address:
  • Phone: 318-448-1801
  • Fax: 318-448-1841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: