Provider Demographics
NPI:1043455413
Name:NESTLEHUTT, ANGELA LEE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEE
Last Name:NESTLEHUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 SOUTH VICTORY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502
Mailing Address - Country:US
Mailing Address - Phone:818-563-2300
Mailing Address - Fax:
Practice Address - Street 1:760 MOUNTAIN VIEW ST
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-4925
Practice Address - Country:US
Practice Address - Phone:626-993-3168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No104100000XBehavioral Health & Social Service ProvidersSocial Worker