Healthcare Provider Details

I. General information

NPI: 1750268793
Provider Name (Legal Business Name): PAUL ANGELO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 SOQUEL DR
SANTA CRUZ CA
95065-1705
US

IV. Provider business mailing address

1555 SOQUEL DR
SANTA CRUZ CA
95065-1705
US

V. Phone/Fax

Practice location:
  • Phone: 831-462-7642
  • Fax:
Mailing address:
  • Phone: 831-462-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: