=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902646508
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGEL MBOPDA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2024
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 CHRISTIANA RD APT K14
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19720-2954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-946-0240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 CHRISTIANA RD APT K14
-----------------------------------------------------
City | NEW CASTLE
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19720-2954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-946-0240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------