Provider Demographics
NPI:1588499388
Name:PERSON, ANGEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:PERSON
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 1:351 BUNGALOW RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-1303
Mailing Address - Country:US
Mailing Address - Phone:937-998-8009
Mailing Address - Fax:937-998-8028
Practice Address - Street 1:600 UNION BLVD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2103
Practice Address - Country:US
Practice Address - Phone:937-998-8009
Practice Address - Fax:937-998-8028
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator