Individual provider Active NPI

Angelica De la Fuente, M.S.

  • Student in an Organized Health Care Education/Training Program
  • Santa Monica, CA
National Provider Identifier
1629446372
Registry record updated Sep 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1339 20TH St
Santa Monica, CA 90404-2033
Phone
(310) 829-8285
NPI assigned
Sep 11, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1339 20TH St
Santa Monica, CA 90404-2033

Mailing address

1339 20TH St
Santa Monica, CA 90404-2033

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171121000595 NY Practitioner - Clinical Psychologist 8628335098 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Nysarc Inc CurrentSince Oct 9, 2017 Accepting new patients
Downtown Bronx Medical Associates PC CurrentSince Mar 1, 2020 Accepting new patients
Physician Affiliate Group of New York PC CurrentSince Aug 19, 2024 Accepting new patients

Locations

234 Eugenio Maria de Hosto Blvd
Bronx, NY 10451
Phone (718) 579-5874

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

83 Maiden Ln
New York, NY 10038
Phone (212) 780-2578

83 Maiden Ln
Fl 7
New York, NY 10038
Phone (212) 780-2564

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441929600000",
    "number": "1629446372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1339 20TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1339 20TH ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042033",
            "telephone_number": "310-829-8285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LA FUENTE",
        "first_name": "ANGELICA",
        "credential": "M.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-09-11",
        "last_updated": "2015-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.