Healthcare Provider Details

I. General information

NPI: 1124386560
Provider Name (Legal Business Name): ANGELA DANIELLE TEBALDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA MAURER DPM

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 POTTERY AVE STE 120
PORT ORCHARD WA
98366-2501
US

IV. Provider business mailing address

PO BOX 843324
LOS ANGELES CA
90084-3324
US

V. Phone/Fax

Practice location:
  • Phone: 425-822-7426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPODI.PO.70135777
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: