Provider Demographics
NPI:1861062697
Name:CABAN, ANGELA MARIE (LAC, DACM)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:CABAN
Suffix:
Gender:F
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5737 RICKETT AVE
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-3103
Mailing Address - Country:US
Mailing Address - Phone:646-229-1252
Mailing Address - Fax:
Practice Address - Street 1:718 WAPPOO RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5860
Practice Address - Country:US
Practice Address - Phone:843-779-2352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist