Individual
ANGELINA LOUISE ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1153 COMO DR, MANTECA, CA 95337-8432
(209) 239-1410
Mailing address
1153 COMO DR, MANTECA, CA 95337-8432
(209) 239-1410
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/22/2019
Last updated
09/22/2019
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