Provider Demographics
NPI:1164541009
Name:DURDIEV, ANGELINA (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:
Last Name:DURDIEV
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3779 WILSON AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3923
Mailing Address - Country:US
Mailing Address - Phone:619-401-3747
Mailing Address - Fax:
Practice Address - Street 1:151 VAN HOUTEN AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4429
Practice Address - Country:US
Practice Address - Phone:619-401-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA592340163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health