Basic Information
| Provider Information | |||||||||
| NPI: | 1831119619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE LOS ANGELES | ||||||||
| FirstName: | SERVANDO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 PERRYRIDGE RD | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068304608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038633637 | ||||||||
| FaxNumber: | 2038633821 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 PERRYRIDGE RD | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068304608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038633637 | ||||||||
| FaxNumber: | 2038633821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 031177 | CT | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.