Provider Demographics
NPI:1649700071
Name:TROTTER, ANGELA O'DELL (MS)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:O'DELL
Last Name:TROTTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8560 VINEYARD AVE STE 504
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4350
Mailing Address - Country:US
Mailing Address - Phone:909-506-0020
Mailing Address - Fax:
Practice Address - Street 1:8560 VINEYARD AVE STE 504
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4350
Practice Address - Country:US
Practice Address - Phone:909-506-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist