Provider Demographics
NPI:1134679053
Name:ANG, DAISY MAE (NP)
Entity Type:Individual
Prefix:
First Name:DAISY MAE
Middle Name:
Last Name:ANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19839 WELBY WAY
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-4340
Mailing Address - Country:US
Mailing Address - Phone:818-579-3061
Mailing Address - Fax:
Practice Address - Street 1:19839 WELBY WAY
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-4340
Practice Address - Country:US
Practice Address - Phone:818-579-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF1016304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily