Provider Demographics
NPI:1023620341
Name:ANGULO, NATALIE LINA (FNP-BC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:LINA
Last Name:ANGULO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:LINA
Other - Last Name:ONTIVEROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12373 HERITAGE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3851
Mailing Address - Country:US
Mailing Address - Phone:626-485-8216
Mailing Address - Fax:
Practice Address - Street 1:3533 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4534
Practice Address - Country:US
Practice Address - Phone:323-734-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012365363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner