Provider Demographics
NPI:1275635575
Name:IACOVINO, ANGELA CERICE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:CERICE
Last Name:IACOVINO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DOVER DRIVE,
Mailing Address - Street 2:SUITE 234
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5515
Mailing Address - Country:US
Mailing Address - Phone:949-642-8193
Mailing Address - Fax:949-325-0817
Practice Address - Street 1:901 DOVER DR
Practice Address - Street 2:SUITE 234
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5538
Practice Address - Country:US
Practice Address - Phone:949-642-8193
Practice Address - Fax:949-325-0817
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26556111N00000X, 111NN1001X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26556OtherCOMMERCIAL
CADC26556Medicaid
CADC26556OtherTRICARE
CADC26556OtherPPO
CADC26556OtherHMO
CADC0265560OtherBLUE CROSS/SHIELD
CADC26556OtherTRICARE
CADC26556OtherPPO