Provider Demographics
NPI:1417152463
Name:WARNEKE, ANGELA KAY
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAY
Last Name:WARNEKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:KAY
Other - Last Name:WARNEKE-ICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 153824
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92195-3824
Mailing Address - Country:US
Mailing Address - Phone:619-701-1536
Mailing Address - Fax:619-741-2636
Practice Address - Street 1:7305 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2230
Practice Address - Country:US
Practice Address - Phone:619-701-1536
Practice Address - Fax:619-741-2636
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88167106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist