Provider Demographics
NPI:1730316720
Name:CEMO, ANGELA CAROL (MPH, LDN, RD, CDE)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CAROL
Last Name:CEMO
Suffix:
Gender:F
Credentials:MPH, LDN, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 RIVER RD
Mailing Address - Street 2:UNIT C
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-4168
Mailing Address - Country:US
Mailing Address - Phone:504-301-2555
Mailing Address - Fax:
Practice Address - Street 1:2817 RIVER RD
Practice Address - Street 2:UNIT C
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-4168
Practice Address - Country:US
Practice Address - Phone:504-301-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA835133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H071OtherMEDICARE, PART B CARRIER