Provider Demographics
NPI:1710314448
Name:ANGELUCCI, ERINA PHYLLIS (CNM)
Entity Type:Individual
Prefix:
First Name:ERINA
Middle Name:PHYLLIS
Last Name:ANGELUCCI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 ENTERPRISE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3212
Mailing Address - Country:US
Mailing Address - Phone:858-337-0727
Mailing Address - Fax:
Practice Address - Street 1:3630 ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3212
Practice Address - Country:US
Practice Address - Phone:858-337-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2074367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife