Provider Demographics
NPI:1215220603
Name:HUBER, ANGELA ANN (LAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:ANN
Last Name:HUBER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11940 DOROTHY ST
Mailing Address - Street 2:APT 4
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5315
Mailing Address - Country:US
Mailing Address - Phone:858-344-0953
Mailing Address - Fax:310-442-9737
Practice Address - Street 1:12304 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2551
Practice Address - Country:US
Practice Address - Phone:858-344-0953
Practice Address - Fax:310-442-9737
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14236171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist