Provider Demographics
NPI:1780380162
Name:CIFUENTES, ANGIE MICHELLE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:MICHELLE
Last Name:CIFUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4038 W 133RD ST APT A
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5979
Mailing Address - Country:US
Mailing Address - Phone:310-343-1763
Mailing Address - Fax:
Practice Address - Street 1:4477 W 118TH ST STE 502
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2260
Practice Address - Country:US
Practice Address - Phone:213-600-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic