=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245876135
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REMYBELLE YNIGUEZ ANG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2019
-----------------------------------------------------
Last Update Date | 11/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22968 SERRA DR
-----------------------------------------------------
City | CARSON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90745-4965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-345-2262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22968 SERRA DR
-----------------------------------------------------
City | CARSON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90745-4965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-345-2262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinical Nurse Specialist
-----------------------------------------------------
License Number | 3288
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------