Provider Demographics
NPI:1578155008
Name:POWELL, ANGELA JUDITH
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JUDITH
Last Name:POWELL
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 1:6136 MORONGO RD
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2056
Mailing Address - Country:US
Mailing Address - Phone:386-795-3728
Mailing Address - Fax:
Practice Address - Street 1:38172 SUMMER RIDGE DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7119
Practice Address - Country:US
Practice Address - Phone:813-440-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD2603957OtherDRIVER LICENSE