1730328923 NPI number — ANGELA THERESE ARENDT M.A., L.M.F.T.

Table of content: SUSAN ANN PRAGACZ NP (NPI 1457540403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730328923 NPI number — ANGELA THERESE ARENDT M.A., L.M.F.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARENDT
Provider First Name:
ANGELA
Provider Middle Name:
THERESE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.M.F.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730328923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 S GLASSELL ST
Provider Second Line Business Mailing Address:
SUITE 100G
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92866-3004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-460-2974
Provider Business Mailing Address Fax Number:
714-281-3960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 S GLASSELL ST
Provider Second Line Business Practice Location Address:
SUITE 100G
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92866-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-460-2974
Provider Business Practice Location Address Fax Number:
714-281-3960
Provider Enumeration Date:
02/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 34953 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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