Basic Information
| Provider Information | |||||||||
| NPI: | 1215921697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANGUIANO | ||||||||
| FirstName: | FRANCISCO | ||||||||
| MiddleName: | ERNESTO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 765 MEDICAL CENTER CT | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919116600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194278892 | ||||||||
| FaxNumber: | 6194227660 | ||||||||
| Practice Location | |||||||||
| Address1: | 765 MEDICAL CENTER CT | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919116600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194278892 | ||||||||
| FaxNumber: | 6194227660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 11/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | G61584 | CA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 00G615840 | 05 | CA | MEDICAID |