Basic Information
Provider Information
NPI: 1841637576
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANGUIANO
FirstName: JOSE
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12900 PARK PLAZA DR STE 150
Address2:  
City: CERRITOS
State: CA
PostalCode: 907039329
CountryCode: US
TelephoneNumber: 5629775639
FaxNumber:  
Practice Location
Address1: 10000 LAKEWOOD BLVD
Address2:  
City: DOWNEY
State: CA
PostalCode: 902404020
CountryCode: US
TelephoneNumber: 5628623684
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/04/2013
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X144256CAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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