Basic Information
| Provider Information | |||||||||
| NPI: | 1740559665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRKMAN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | IRVING | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18302 IRVINE BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927803435 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 18302 IRVINE BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927803435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149571004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2011 | ||||||||
| LastUpdateDate: | 12/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | ASW 23800 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.