Provider Demographics
NPI:1144027442
Name:ALFORD, ANGELA RAE (CERTIFICATE)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RAE
Last Name:ALFORD
Suffix:
Gender:F
Credentials:CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 CALLANDER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-2204
Mailing Address - Country:US
Mailing Address - Phone:559-632-4716
Mailing Address - Fax:
Practice Address - Street 1:4640 SPYRES WAY
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9800
Practice Address - Country:US
Practice Address - Phone:559-632-4716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist