Healthcare Provider Details

I. General information

NPI: 1477678050
Provider Name (Legal Business Name): MARGUERITE S DEANGELO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD BLDG. 200, FLOOR ONE, SUITE 105
SALINAS CA
93906-3100
US

IV. Provider business mailing address

1615 BUNKER HILL WAY SUITE 100
SALINAS CA
93906-6013
US

V. Phone/Fax

Practice location:
  • Phone: 831-769-8660
  • Fax: 831-769-8655
Mailing address:
  • Phone: 831-796-1304
  • Fax: 831-757-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11586
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15415
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: