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General NPI Number Information
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NPI Number | 1396002523
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Entity Type | Individual
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Provider Name | ANGELA LUCAS TITO RN
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Gender | Female
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 8 GLORIETA E
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City | IRVINE
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State | CA
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Zip | 92620-1849
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Country | US
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Telephone | 812-455-5003
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Fax |
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Provider Business Mailing Address
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Address Line | 1290 N COAST HWY APT. A
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-1339
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Country | US
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Telephone | 812-455-5003
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Fax |
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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 | 163WN0002X
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Taxonomy Name | Neonatal Intensive Care Registered Nurse
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License Number | 70312
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License Number State | CA
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