Healthcare Provider Details

I. General information

NPI: 1700282423
Provider Name (Legal Business Name): MICHAEL ANGEL CFO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 L ST
SACRAMENTO CA
95816-5225
US

IV. Provider business mailing address

3001 L ST
SACRAMENTO CA
95816-5225
US

V. Phone/Fax

Practice location:
  • Phone: 916-706-1520
  • Fax: 916-706-1551
Mailing address:
  • Phone: 916-706-1520
  • Fax: 916-706-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: