Provider Demographics
NPI:1578841946
Name:CANGIALOSI, THERESA ANNE (NP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANNE
Last Name:CANGIALOSI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3261
Mailing Address - Country:US
Mailing Address - Phone:310-697-6833
Mailing Address - Fax:
Practice Address - Street 1:3833 WORSHAM AVE STE 301
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1766
Practice Address - Country:US
Practice Address - Phone:562-595-5479
Practice Address - Fax:562-988-7616
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA9281363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics