Healthcare Provider Details

I. General information

NPI: 1134574783
Provider Name (Legal Business Name): WARREN G ANSALDO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7038 KATELLA AVE
STANTON CA
90680-2805
US

IV. Provider business mailing address

798 SAINT JAMES DR
CORONA CA
92882-8829
US

V. Phone/Fax

Practice location:
  • Phone: 714-895-4899
  • Fax:
Mailing address:
  • Phone: 949-689-4332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT33418TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number33418TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: