Provider Demographics
NPI:1043894314
Name:ALANIS, ANGELIQUE RUFINA
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:RUFINA
Last Name:ALANIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 WOODLAWN AVE APT M
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5149
Mailing Address - Country:US
Mailing Address - Phone:408-569-9357
Mailing Address - Fax:
Practice Address - Street 1:520 WOODLAWN AVE APT M
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5149
Practice Address - Country:US
Practice Address - Phone:408-569-9357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69712225700000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist