Provider Demographics
NPI:1932719762
Name:LAT, ANGELICA (NP, AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:
Last Name:LAT
Suffix:
Gender:F
Credentials:NP, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 WHITTIER BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2338
Mailing Address - Country:US
Mailing Address - Phone:562-904-5000
Mailing Address - Fax:
Practice Address - Street 1:15725 WHITTIER BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2338
Practice Address - Country:US
Practice Address - Phone:562-904-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012986363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care