Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 225400000X | Rehabilitation Practitioner | CA |
NPI | 1043455413 |
---|---|
Provider Name | Angela Lee Nestlehutt |
First Address | Burbank, CA 91502 |
Second Address | Altadena, CA 91001-4925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2008 |
Last Update Date | 24/11/2014 |