MEDICARE: DR. ANGEL L. ISCOVICH M.D.

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	207P00000X	Emergency Medicine Physician	G42205	CA

General Provider Information

NPI Number	:	1205884517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGEL L. ISCOVICH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 30440
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93130
Country	:	US
Telephone Number	:	469-401-2386
Fax Number	:

Provider Business Practice Location Address
First Line	:	13737 NOEL RD
Second Line	:	STE 1600
City	:	DALLAS
State	:	TX
Zip	:	75240-1331
Country	:	US
Telephone Number	:	469-401-2386
Fax Number	:

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	05/29/2017

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