Basic Information
| Provider Information | |||||||||
| NPI: | 1023129046 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4280 CAMINITO PINTORESCO | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921084230 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3350 LA JOLLA VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586423113 | ||||||||
| FaxNumber: | 8585524315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC2100X | 189407 | CA | X | Nursing Service Providers | Registered Nurse | Continence Care | 163WR0400X | 189407 | CA | X | Nursing Service Providers | Registered Nurse | Rehabilitation | 163WU0100X | 189407 | CA | X | Nursing Service Providers | Registered Nurse | Urology |
ID Information
| ID | Type | State | Issuer | Description | 189407 | 01 | CA | RN LICENSE | OTHER | 468 | 01 | CA | CNS CERTIFICATE | OTHER |