Provider Demographics
NPI:1598465577
Name:BEAUDOIN-LUU, ANGELENA K
Entity Type:Individual
Prefix:
First Name:ANGELENA
Middle Name:K
Last Name:BEAUDOIN-LUU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELENA
Other - Middle Name:K
Other - Last Name:LUU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11184 WHITEWATER AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-6449
Mailing Address - Country:US
Mailing Address - Phone:503-440-8155
Mailing Address - Fax:
Practice Address - Street 1:1520 N MOUNTAIN AVE STE 206
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1133
Practice Address - Country:US
Practice Address - Phone:909-689-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician