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General NPI Number Information
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NPI Number | 1164393856
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Entity Type | Organization
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Legal Business Name | ANGEL SQUAD INC.
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 1756 WESTWOOD BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90024-5608
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Country | US
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Telephone | 310-474-4787
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Fax |
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Provider Business Mailing Address
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Address Line | 1733 S SPAULDING AVE
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City | LOS ANGELES
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State | CA
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Zip | 90019-5034
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Country | US
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Telephone | 310-474-4787
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Fax |
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Authorized Official
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Title or Position | COO
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Name | TINA REYNOLDS
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Credential |
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Telephone | 323-573-5172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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