Provider Demographics
NPI:1447057062
Name:DEITCH, ANGELA LYNN
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:DEITCH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:LIEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1430 CLEARVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1049
Mailing Address - Country:US
Mailing Address - Phone:760-492-9215
Mailing Address - Fax:
Practice Address - Street 1:1430 CLEARVIEW WAY
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1049
Practice Address - Country:US
Practice Address - Phone:760-492-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty