Healthcare Provider Details

I. General information

NPI: 1679409072
Provider Name (Legal Business Name): ANGELICA PIERRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 S ALAMEDA ST
CORPUS CHRISTI TX
78411-1721
US

IV. Provider business mailing address

7471 SHOSHONE AVE
LAKE BALBOA CA
91406-2342
US

V. Phone/Fax

Practice location:
  • Phone: 361-694-5000
  • Fax:
Mailing address:
  • Phone: 805-236-1232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMB-831185
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: