Healthcare Provider Details

I. General information

NPI: 1417292707
Provider Name (Legal Business Name): ANGELS PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E ALLUVIAL AVE STE 105
FRESNO CA
93720-3832
US

IV. Provider business mailing address

1515 E ALLUVIAL AVE STE 105
FRESNO CA
93720-3832
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-5515
  • Fax: 559-322-5915
Mailing address:
  • Phone: 559-322-5515
  • Fax: 559-322-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA110082
License Number StateCA

VIII. Authorized Official

Name: DR. ENAS ATTIA
Title or Position: OWNER OF ANGELS PEDIATRICS, INC.
Credential: MD
Phone: 559-322-5515