Provider Demographics
NPI:1750891446
Name:HUDSON, ANGELA LYNN (PMHNP, FNP, PHD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PMHNP, FNP, PHD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP, FNP
Mailing Address - Street 1:230 MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3476
Mailing Address - Country:US
Mailing Address - Phone:310-709-8234
Mailing Address - Fax:
Practice Address - Street 1:4281 KATELLA AVE STE 215
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720
Practice Address - Country:US
Practice Address - Phone:714-826-2941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397230363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health