Provider Demographics
NPI:1013319938
Name:DIPIETRO, ANGELA CHRISTINE (RAS)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:DIPIETRO
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:CHRISTINE
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6265 SEPULVEDA BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1127
Mailing Address - Country:US
Mailing Address - Phone:818-779-0555
Mailing Address - Fax:818-779-0455
Practice Address - Street 1:6265 SEPULVEDA BLVD STE 10
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1127
Practice Address - Country:US
Practice Address - Phone:818-779-0555
Practice Address - Fax:818-779-0455
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB0602150343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist