Provider Demographics
NPI:1275994675
Name:RETANO, ANGELICA GRETHEL
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:GRETHEL
Last Name:RETANO
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 1:13217 AURORA DR
Mailing Address - Street 2:49
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-1800
Mailing Address - Country:US
Mailing Address - Phone:619-654-6277
Mailing Address - Fax:
Practice Address - Street 1:13217 AURORA DR
Practice Address - Street 2:49
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-1800
Practice Address - Country:US
Practice Address - Phone:619-654-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN266966164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse