Provider Demographics
NPI:1386439602
Name:JEGEN MARIN, ANGIE GISEL
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:GISEL
Last Name:JEGEN MARIN
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 1:949 N PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-2724
Mailing Address - Country:US
Mailing Address - Phone:559-500-1999
Mailing Address - Fax:
Practice Address - Street 1:949 N PARKWAY DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2724
Practice Address - Country:US
Practice Address - Phone:559-500-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-OYRDZF175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist