Healthcare Provider Details

I. General information

NPI: 1013159912
Provider Name (Legal Business Name): CARLOS MANUEL ANGELES SAN MATEO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 OCONNOR DR STE 270
SAN JOSE CA
95128-1644
US

IV. Provider business mailing address

455 OCONNOR DR STE 270
SAN JOSE CA
95128-1644
US

V. Phone/Fax

Practice location:
  • Phone: 415-939-0928
  • Fax:
Mailing address:
  • Phone: 408-707-1410
  • Fax: 866-531-9599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME125705
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA137904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: