Provider Demographics
NPI:1043766363
Name:RANGEL, AMBER JOY (PA-C, MPAP)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:JOY
Last Name:RANGEL
Suffix:
Gender:F
Credentials:PA-C, MPAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 642292
Mailing Address - Street 2:11270 EXPOSITION BLVD FL 1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064
Mailing Address - Country:US
Mailing Address - Phone:310-999-9592
Mailing Address - Fax:
Practice Address - Street 1:2990 S SEPULVEDA BLVD # 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-0002
Practice Address - Country:US
Practice Address - Phone:323-421-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53556363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical