Provider Demographics
NPI:1295909711
Name:YVONNE, ANGELA (LAC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:YVONNE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 RUFFIN RD STE 315
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1868
Mailing Address - Country:US
Mailing Address - Phone:619-917-2958
Mailing Address - Fax:619-924-4409
Practice Address - Street 1:3645 RUFFIN RD STE 315
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1868
Practice Address - Country:US
Practice Address - Phone:619-917-2958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12296171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist