Provider Demographics
NPI:1023129046
Name:JOSEPH, ANGELA (MSN)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4280 CAMINITO PINTORESCO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1806
Practice Address - Country:US
Practice Address - Phone:858-642-3113
Practice Address - Fax:858-552-4315
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA189407163WC2100X, 163WR0400X, 163WU0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC2100XNursing Service ProvidersRegistered NurseContinence Care
Not Answered163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
Not Answered163WU0100XNursing Service ProvidersRegistered NurseUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA189407OtherRN LICENSE
CA468OtherCNS CERTIFICATE