Healthcare Provider Details

I. General information

NPI: 1962403493
Provider Name (Legal Business Name): ANGELA LYNN HERRMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

630 S GLASSELL ST SUITE 106-A
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:
Title or Position:
Credential:
Phone: