Healthcare Provider Details

I. General information

NPI: 1972628931
Provider Name (Legal Business Name): ANGELES LOSADA MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23370 ROAD 22
CHOWCHILLA CA
93610-8504
US

IV. Provider business mailing address

4655 CASS ST STE 112
SAN DIEGO CA
92109-2810
US

V. Phone/Fax

Practice location:
  • Phone: 559-665-5531
  • Fax:
Mailing address:
  • Phone: 786-419-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA49228
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME75913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: