Provider Demographics
NPI:1508328857
Name:COBURN, ANGELICA MICHELE
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MICHELE
Last Name:COBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:MICHELE
Other - Last Name:CASTRICONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6109 AFTON PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8313
Mailing Address - Country:US
Mailing Address - Phone:323-461-4118
Mailing Address - Fax:323-461-4119
Practice Address - Street 1:2150 N VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-7791
Practice Address - Country:US
Practice Address - Phone:805-382-6296
Practice Address - Fax:805-382-9487
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)