Healthcare Provider Details

I. General information

NPI: 1922240258
Provider Name (Legal Business Name): ANGELA HERRMANN MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S GLASSELL ST SUITE 106A
ORANGE CA
92866-3004
US

IV. Provider business mailing address

630 S GLASSELL ST SUITE 106A
ORANGE CA
92866-3004
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-9691
  • Fax: 714-639-6580
Mailing address:
  • Phone: 714-639-9691
  • Fax: 714-639-6580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA75988
License Number StateCA

VIII. Authorized Official

Name: DR. ANGELA HERRMANN
Title or Position: PRESIDENT
Credential: MD
Phone: 714-639-9691