Provider Demographics
NPI:1386195105
Name:CUYUGAN, MA ANGELICA
Entity Type:Individual
Prefix:
First Name:MA ANGELICA
Middle Name:
Last Name:CUYUGAN
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 1:2621 S BRISTOL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2621 S BRISTOL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5766
Practice Address - Country:US
Practice Address - Phone:657-900-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily