Provider Demographics
NPI:1194964684
Name:GUSTAVE-MORGAN, ANGELA ANNETTE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ANNETTE
Last Name:GUSTAVE-MORGAN
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 1:16718 NICKLAUS DR UNIT 60
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1675
Mailing Address - Country:US
Mailing Address - Phone:213-248-3516
Mailing Address - Fax:
Practice Address - Street 1:6736 LAUREL CANYON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1576
Practice Address - Country:US
Practice Address - Phone:818-755-8786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-07
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor