MEDICARE: MR. CHAD JOSEPH ANGOTTA M.A., M.F.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC18168	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MFC18168	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1134101611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHAD JOSEPH ANGOTTA M.A., M.F.T.

Provider Business Mailing Address
First Line	:	17452 IRVINE BLVD
Second Line	:	SUITE #214
City	:	TUSTIN
State	:	CA
Zip	:	92780-3031
Country	:	US
Telephone Number	:	714-731-6111
Fax Number	:

Provider Business Practice Location Address
First Line	:	17452 IRVINE BLVD
Second Line	:	SUITE #214
City	:	TUSTIN
State	:	CA
Zip	:	92780-3031
Country	:	US
Telephone Number	:	714-731-6111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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