Provider Demographics
NPI:1942384789
Name:FOGLE, ANNA MARGARITA SANTOS (LVN)
Entity Type:Individual
Prefix:MRS
First Name:ANNA MARGARITA
Middle Name:SANTOS
Last Name:FOGLE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:ANNA MARGARITA
Other - Middle Name:SANTOS
Other - Last Name:LIBREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:7696 FLANDERS DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3063
Mailing Address - Country:US
Mailing Address - Phone:619-254-7244
Mailing Address - Fax:
Practice Address - Street 1:2292 PEACH TREE LN
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-7046
Practice Address - Country:US
Practice Address - Phone:619-254-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211484164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN004090OtherMEDI-CAL PROVIDER