Individual
ANGELA EDET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1800 N CALIFORNIA ST, STOCKTON, CA 95204-6019
(209) 547-7143
Mailing address
1800 N CALIFORNIA ST, STOCKTON, CA 95204-6019
(209) 547-7143
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390200000X
—
CA
Enumeration date
04/23/2019
Last updated
06/11/2019
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