Provider Demographics
NPI:1649742503
Name:PATRIARCA, ANGELA KIM
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KIM
Last Name:PATRIARCA
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 1:2801 B ST # 243
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-2208
Mailing Address - Country:US
Mailing Address - Phone:323-377-2450
Mailing Address - Fax:
Practice Address - Street 1:2515 CAMINO DEL RIO S STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3714
Practice Address - Country:US
Practice Address - Phone:619-688-0061
Practice Address - Fax:619-688-0026
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18287171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist