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General NPI Number Information
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NPI Number | 1396465969
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Entity Type | Individual
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Provider Name | ANGELA SUZANNE COASTON FNP
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Gender | Female
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 12984 HESPERIA RD
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City | VICTORVILLE
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State | CA
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Zip | 92395-5819
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Country | US
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Telephone | 909-268-1086
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Fax |
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Provider Business Mailing Address
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Address Line | 14213 LAURAMORE CT
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City | FONTANA
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State | CA
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Zip | 92336-3541
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Country | US
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Telephone | 909-268-1086
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 21766
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License Number State | CA
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