Provider Demographics
NPI:1093757742
Name:ENGLAND, ANGELYN LENNERTZ
Entity Type:Individual
Prefix:
First Name:ANGELYN
Middle Name:LENNERTZ
Last Name:ENGLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANGELYN
Other - Middle Name:MARIE
Other - Last Name:LENNERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4612 MILNE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3336
Mailing Address - Country:US
Mailing Address - Phone:310-210-9427
Mailing Address - Fax:
Practice Address - Street 1:400 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6814
Practice Address - Country:US
Practice Address - Phone:310-546-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16669363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P82368Medicare UPIN