Provider Demographics
NPI:1225407646
Name:ANGEL, VICTORIA MORGAN GEORGINA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MORGAN GEORGINA
Last Name:ANGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 CALIFORNIA AVE SW
Mailing Address - Street 2:#22
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3367
Mailing Address - Country:US
Mailing Address - Phone:949-573-5342
Mailing Address - Fax:
Practice Address - Street 1:5236 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE D
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1244
Practice Address - Country:US
Practice Address - Phone:206-331-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60598326225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist