1528117660 NPI number — HERMENEGILDO G ANGELES JR MD APC

Table of content: (NPI 1528117660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528117660 NPI number — HERMENEGILDO G ANGELES JR MD APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERMENEGILDO G ANGELES JR MD APC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528117660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 SULLIVAN AVE
Provider Second Line Business Mailing Address:
SUITE #310
Provider Business Mailing Address City Name:
DALY CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94015-2221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-755-3939
Provider Business Mailing Address Fax Number:
650-755-3883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 SULLIVAN AVENUE
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
DALU CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-755-3939
Provider Business Practice Location Address Fax Number:
650-755-3883
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANGELES
Authorized Official First Name:
HERMENEGILDO
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
650-270-0065

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A066103 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CT956A . This is a "MEDICARE PTAN NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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