Active NPI
Angella Wilson
- Rehabilitation Practitioner
- Long Beach, CA
National Provider Identifier
1356596175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- ASW21115
- Practice address
- 2931 Redondo Ave
Long Beach, CA 90806-2445 - Phone
- (562) 490-7600
- Fax
- (562) 490-7601
- NPI assigned
- Nov 20, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | ASW21115 | CA | Primary |
Addresses
Primary practice location
2931 Redondo Ave
Long Beach, CA 90806-2445
Mailing address
11306 Payton
Irvine, CA 92620-3503
Phone (714) 360-9758
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ASW21115 | CA | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227139200000",
"number": "1356596175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11306 PAYTON",
"city": "IRVINE",
"state": "CA",
"postal_code": "926203503",
"telephone_number": "714-360-9758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2931 REDONDO AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908062445",
"telephone_number": "562-490-7600",
"fax_number": "562-490-7601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ANGELLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-20",
"last_updated": "2008-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "CA",
"license": "ASW21115",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.