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General NPI Number Information
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NPI Number | 1720571581
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Entity Type | Organization
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Legal Business Name | 805 ANGELS LLC
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Dates
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Enumeration Date | 06/07/2018
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 5565 CARPINTERIA AVE STE 1
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City | CARPINTERIA
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State | CA
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Zip | 93013
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Country | US
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Telephone | 805-284-0221
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Fax | 805-284-0223
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Provider Business Mailing Address
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Address Line | 5565 CARPINTERIA AVE STE 1
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City | CARPINTERIA
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State | CA
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Zip | 93013
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Country | US
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Telephone | 805-284-0221
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Fax | 805-284-0223
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. LYDIA TULLY-ROOS
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Credential | PHD
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Telephone | 805-284-0221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 4247000Z0
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License Number State | CA
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