Provider Demographics
NPI:1043926082
Name:VAULT, ANGELIQUE M
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:M
Last Name:VAULT
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 1:582 ROCKY HILL RD APT 209
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-2267
Mailing Address - Country:US
Mailing Address - Phone:916-670-8760
Mailing Address - Fax:
Practice Address - Street 1:582 ROCKY HILL RD APT 209
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-2267
Practice Address - Country:US
Practice Address - Phone:916-670-8760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company