Provider Demographics
NPI:1437649662
Name:MILLAN, ANGELA GABRIELLE (NP)
Entity type:Individual
Prefix:
First Name:ANGELA GABRIELLE
Middle Name:
Last Name:MILLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MILLAN
Other - Last Name:BAUTISTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:501 N GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3312
Mailing Address - Country:US
Mailing Address - Phone:818-291-8900
Mailing Address - Fax:
Practice Address - Street 1:501 N GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-3312
Practice Address - Country:US
Practice Address - Phone:818-891-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005548363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner