Provider Demographics
NPI:1952182248
Name:BRIGHTMON, ANGELICA RUTH
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:RUTH
Last Name:BRIGHTMON
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 1:941 SOUTH VERMONT AVENUE
Mailing Address - Street 2:STE 101 #238
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006
Mailing Address - Country:US
Mailing Address - Phone:213-282-0901
Mailing Address - Fax:
Practice Address - Street 1:341 W 47TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-3234
Practice Address - Country:US
Practice Address - Phone:213-282-0901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator