Provider Demographics
NPI:1215414537
Name:TRUONG, ANGIE (MA)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:TRUONG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 CORPORATE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-7609
Mailing Address - Country:US
Mailing Address - Phone:949-205-6560
Mailing Address - Fax:
Practice Address - Street 1:1832 S 4TH ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3524
Practice Address - Country:US
Practice Address - Phone:626-789-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst