Provider Demographics
NPI:1396002523
Name:TITO, ANGELA LUCAS (RN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LUCAS
Last Name:TITO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 N COAST HWY
Mailing Address - Street 2:APT. A
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1339
Mailing Address - Country:US
Mailing Address - Phone:812-455-5003
Mailing Address - Fax:
Practice Address - Street 1:8 GLORIETA E
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1849
Practice Address - Country:US
Practice Address - Phone:812-455-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70312163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care