Provider Demographics
NPI:1457038564
Name:PONTICELLI, ANGELA LEIGHANNE (LVN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LEIGHANNE
Last Name:PONTICELLI
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27791 ABADEJO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-2519
Mailing Address - Country:US
Mailing Address - Phone:949-244-2298
Mailing Address - Fax:
Practice Address - Street 1:27791 ABADEJO
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-2519
Practice Address - Country:US
Practice Address - Phone:949-244-2298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288905164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse