Angie Ellaboudy, DNP, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

95020643 Issued in CA

Practice address

26700 Towne Centre Dr Ste 150
Foothill Ranch, CA 92610-2845

Phone

(949) 837-7337

NPI assigned

Aug 13, 2022

Last updated

Aug 13, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Oc Pediatrics Medical Group Inc

  • Pediatrics Physician
  • Foothill Ranch, CA
  • NPI 1912265257
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660348800000",
    "number": "1083342307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 W WEEPING WILLOW AVE",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928651089",
            "telephone_number": "714-679-9890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26700 TOWNE CENTRE DR STE 150",
            "city": "FOOTHILL RANCH",
            "state": "CA",
            "postal_code": "926102845",
            "telephone_number": "949-837-7337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLABOUDY",
        "first_name": "ANGIE",
        "name_prefix": "Dr.",
        "credential": "DNP, CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-13",
        "last_updated": "2022-08-13",
        "certification_date": "2022-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "95020643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NP LICENSE/FURNISHING NUMBER",
            "identifier": "NP95020643",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@ocpediatrics.com",
            "affiliation": "N",
            "address_1": "26700 Towne Centre Dr Ste 150",
            "city": "Foothill Ranch",
            "state": "CA",
            "country_code": "US",
            "postal_code": "926102845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Garrick Jordan Dzoan
• Lisa M Eaton, MSW, LSW
• Elaine T Shim DDS PC
• Elitecare SVCS
• Elitecare SVCS
• Hamid Eskandari, MD
• Eye Care West Optometry Oc
• Farnaz Farokhi
• Amy Farrell, PHARMD
• Firstsight Vision Services, Inc.

• Pediatric Nurse Practitioner in Foothill Ranch, CA
• Providers in Foothill Ranch, CA by specialty
• Pediatric Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.