Provider Demographics
NPI:1124720164
Name:CANGELOSI, KELLY MICHELLE
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELLE
Last Name:CANGELOSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 494100
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-4100
Mailing Address - Country:US
Mailing Address - Phone:530-224-7160
Mailing Address - Fax:
Practice Address - Street 1:3191 CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2123
Practice Address - Country:US
Practice Address - Phone:530-224-7160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator