Healthcare Provider Details

I. General information

NPI: 1346162989
Provider Name (Legal Business Name): VINCE ANGELO ANGALOT ASUNCION
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 LOS GAMOS DR
SAN RAFAEL CA
94903-1838
US

IV. Provider business mailing address

2421 JUDAH ST APT 8
SAN FRANCISCO CA
94122-1467
US

V. Phone/Fax

Practice location:
  • Phone: 415-444-2962
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: