Basic Information
| Provider Information | |||||||||
| NPI: | 1710369202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGULO | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | GABRIELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 CITRACADO PKWY | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920256428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602949270 | ||||||||
| FaxNumber: | 7602949268 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 CITRACADO PKWY | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920256428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602949270 | ||||||||
| FaxNumber: | 7602949268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2015 | ||||||||
| LastUpdateDate: | 06/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.