Provider Demographics
NPI:1346623634
Name:STORCK-PETERSEN, ANGELA CHRISTINE (MPH, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:STORCK-PETERSEN
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:CHRISTINE
Other - Last Name:HARVEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH, RD, LD
Mailing Address - Street 1:11768 CAMINITO CORRIENTE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4548
Mailing Address - Country:US
Mailing Address - Phone:626-840-4177
Mailing Address - Fax:626-768-7671
Practice Address - Street 1:11768 CAMINITO CORRIENTE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128
Practice Address - Country:US
Practice Address - Phone:626-840-4177
Practice Address - Fax:626-768-7671
Is Sole Proprietor?:No
Enumeration Date:2015-07-04
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32903-DI-2133V00000X
CA1051996133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered