Healthcare Provider Details

I. General information

NPI: 1720045412
Provider Name (Legal Business Name): NIREN ANGLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24411 HEALTH CENTER DR SUITE 350
LAGUNA HILLS CA
92653-3651
US

IV. Provider business mailing address

1320 EL CAPITAN DR STE 120
DANVILLE CA
94526-6260
US

V. Phone/Fax

Practice location:
  • Phone: 949-457-7900
  • Fax:
Mailing address:
  • Phone: 925-239-2549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG78968
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG78968
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: