Provider Demographics
NPI:1174760938
Name:ANGELO-TARANGO, REGINA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:ANGELO-TARANGO
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 1:1801 HUNTINGTON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2687
Mailing Address - Country:US
Mailing Address - Phone:626-301-9700
Mailing Address - Fax:
Practice Address - Street 1:1801 HUNTINGTON DR STE 200
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2687
Practice Address - Country:US
Practice Address - Phone:626-301-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 53554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist