Healthcare Provider Details

I. General information

NPI: 1609367242
Provider Name (Legal Business Name): RICARDO ANGELES BCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N BEDFORD DR STE 411
BEVERLY HILLS CA
90210-4340
US

IV. Provider business mailing address

435 N BEDFORD DR STE 411
BEVERLY HILLS CA
90210-4340
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-8801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: