Provider Information for 1750790366
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ANGELA ROSE LMFT 98940
Sex: Female
NPI: 1750790366
Last Updated: 2019-06-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1750790366 | ||||||||||||
| Enumeration Date | 2014-08-07 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 576 FELTON, CA 95018-0576 United States Phone: 831-471-7165 | Fax: | ||||||||||||
| Primary Practice Address | 2901 PARK AVE STE B10 SOQUEL, CA 95073-2831 United States Phone: 831-471-7165 | Fax: | ||||||||||||
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