Healthcare Provider Details

I. General information

NPI: 1275519845
Provider Name (Legal Business Name): JEFF ANGAROLA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30300 RANCHO VIEJO RD
SAN JUAN CAPISTRANO CA
92675-1576
US

IV. Provider business mailing address

3828 SCHAUFELE AVE STE 200
LONG BEACH CA
90808-1793
US

V. Phone/Fax

Practice location:
  • Phone: 949-661-9600
  • Fax: 949-443-6200
Mailing address:
  • Phone: 714-665-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE3437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: