Provider Demographics
NPI:1801649363
Name:DEANGELIS, ALECIA (PMHNP)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:DEANGELIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 HARBOR BLVD APT 202
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6601
Mailing Address - Country:US
Mailing Address - Phone:602-802-4344
Mailing Address - Fax:
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 443
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6375
Practice Address - Country:US
Practice Address - Phone:949-200-7929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95029651363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health