=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265247449
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA TEJEDA FLORES CPT1
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2025
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15233 VENTURA BLVD STE 500
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-2231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-343-1608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15233 VENTURA BLVD STE 500
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-2231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 747-343-1608
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number | CPT-00031139
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------