Provider Demographics
NPI:1386439602
Name:JEGEN, ANGIE GISEL
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:GISEL
Last Name:JEGEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12390 GOLDEN STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-9156
Mailing Address - Country:US
Mailing Address - Phone:559-660-4600
Mailing Address - Fax:
Practice Address - Street 1:12390 GOLDEN STATE BLVD
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-9156
Practice Address - Country:US
Practice Address - Phone:559-660-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker