Healthcare Provider Details

I. General information

NPI: 1932154119
Provider Name (Legal Business Name): EMMANUEL S ANGELES N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33758 YUCAIPA BLVD
YUCAIPA CA
92399-2243
US

IV. Provider business mailing address

PO BOX 10069
SAN BERNARDINO CA
92423-0069
US

V. Phone/Fax

Practice location:
  • Phone: 909-795-9747
  • Fax: 909-797-1191
Mailing address:
  • Phone: 909-335-4188
  • Fax: 909-335-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: