Provider Demographics
NPI:1740798883
Name:ANGEL, ANNIE K
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:K
Last Name:ANGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:KIET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANNIE KIET
Mailing Address - Street 1:562 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2502
Mailing Address - Country:US
Mailing Address - Phone:760-691-9622
Mailing Address - Fax:442-999-5740
Practice Address - Street 1:562 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2502
Practice Address - Country:US
Practice Address - Phone:760-691-9622
Practice Address - Fax:442-999-5740
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
CA1-18-32016103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician