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General NPI Number Information
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NPI Number | 1275635575
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Entity Type | Individual
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Provider Name | ANGELA CERICE IACOVINO D.C.
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Gender | Female
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 901 DOVER DR SUITE 234
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5538
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Country | US
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Telephone | 949-642-8193
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Fax | 949-325-0817
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Provider Business Mailing Address
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Address Line | 901 DOVER DRIVE, SUITE 234
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5515
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Country | US
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Telephone | 949-642-8193
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Fax | 949-325-0817
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC26556
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | DC26556
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC26556
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License Number State | CA
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