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NPI Code Detail

MEDICARE: ANGIE BOZEMAN

MEDICARE: ANGIE BOZEMAN
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
12355S0801XSpeech-Language Assistant4888CA

General Provider Information

NPI Number : 1922584408
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGIE BOZEMAN
Provider Business Mailing Address
First Line : 25338 WALNUT ST SPC 22
Second Line :
City : LOMITA
State : CA
Zip : 90717-1972
Country : US
Telephone Number : 424-285-9411
Fax Number :
Provider Business Practice Location Address
First Line : 3521 LOMITA BLVD STE 201
Second Line :
City : TORRANCE
State : CA
Zip : 90505-5040
Country : US
Telephone Number : 310-856-8528
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2018
Last Update Date : 07/17/2018

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Directions to “ ANGIE BOZEMAN ” Practice Location

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