Provider Demographics
NPI:1659951663
Name:PUENTE, ANGELICA (RN)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:PUENTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 S DANA AVE
Mailing Address - Street 2:
Mailing Address - City:PLANADA
Mailing Address - State:CA
Mailing Address - Zip Code:95365-8013
Mailing Address - Country:US
Mailing Address - Phone:209-205-0002
Mailing Address - Fax:855-354-6161
Practice Address - Street 1:81 S DANA AVE
Practice Address - Street 2:
Practice Address - City:PLANADA
Practice Address - State:CA
Practice Address - Zip Code:95365-8013
Practice Address - Country:US
Practice Address - Phone:209-205-0002
Practice Address - Fax:855-354-6161
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA687374163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse