Basic Information
| Provider Information | |||||||||
| NPI: | 1740462803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANEL-TIANGCO | ||||||||
| FirstName: | RAQUEL DE LEON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ANEL | ||||||||
| OtherFirstName: | RAQUEL MARGUERITE | ||||||||
| OtherMiddleName: | DE LEON | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 86370 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571186370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227510 | ||||||||
| FaxNumber: | 6053226475 | ||||||||
| Practice Location | |||||||||
| Address1: | 1315 S. CLIFF AVE. | ||||||||
| Address2: | STE. 3000 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053227600 | ||||||||
| FaxNumber: | 6053227601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2007 | ||||||||
| LastUpdateDate: | 10/11/2018 | ||||||||
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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 | 207R00000X | MD435941 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 8278 | SD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 002098747 | 01 | HIGHMARK BLUE SHIELD | OTHER | 1023034030002 | 05 | PA | MEDICAID | 1023034030001 | 05 | PA | MEDICAID | 6007450 | 05 | SD | MEDICAID |