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NPI Code Detail

MEDICARE: ANGELA NOSSETT M.D.

MEDICARE: ANGELA NOSSETT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianA071543CA

General Provider Information

NPI Number : 1194754457
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA NOSSETT M.D.
Provider Business Mailing Address
First Line : 245 S FETTERLY AVE
Second Line : RM 2284
City : LOS ANGELES
State : CA
Zip : 90022-1605
Country : US
Telephone Number : 332-780-2205
Fax Number : 323-264-3771
Provider Business Practice Location Address
First Line : 245 S FETTERLY AVE
Second Line : RM 2284
City : LOS ANGELES
State : CA
Zip : 90022-1605
Country : US
Telephone Number : 332-780-2205
Fax Number : 323-264-3771
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 07/08/2007

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