Provider Demographics
NPI:1770139487
Name:ANGELIAN MANAGEMENT GROUP LLC
Entity type:Organization
Organization Name:ANGELIAN MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:YACKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-933-6546
Mailing Address - Street 1:23551 MOULTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1911
Mailing Address - Country:US
Mailing Address - Phone:949-707-1707
Mailing Address - Fax:949-258-5117
Practice Address - Street 1:23551 MOULTON PKWY
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1911
Practice Address - Country:US
Practice Address - Phone:949-707-1707
Practice Address - Fax:949-258-5117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care