Provider Demographics
NPI:1952577033
Name:TREMBLE, ANGELIQUE (PA)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:
Last Name:TREMBLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 BELLEVUE AVE
Mailing Address - Street 2:209
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3462
Mailing Address - Country:US
Mailing Address - Phone:510-986-0715
Mailing Address - Fax:
Practice Address - Street 1:396 BELLEVUE AVE
Practice Address - Street 2:209
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3462
Practice Address - Country:US
Practice Address - Phone:510-986-0715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19116363AM0700X
CA19116363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical