Individual
ANGELIQUE VICKIE COLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3642 BLUE GUM ST, CLEARLAKE, CA 95422-7939
(707) 266-9150
Mailing address
16745 BIG BEAR RD, LOWER LAKE, CA 95457-9712
(707) 206-5204
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
172V00000X
Community Health Worker
Primary
—
—
177F00000X
Lodging Provider
—
—
Other
Enumeration date
02/28/2025
Last updated
02/28/2025
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