Healthcare Provider Details

I. General information

NPI: 1104322874
Provider Name (Legal Business Name): ANGELO TRIGOSO JARA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL OFFICE BUILDING 2000 OLATHE BLVD
KANSAS CITY KS
66160-0001
US

IV. Provider business mailing address

MEDICAL OFFICE BUILDING 2000 OLATHE BLVD
KANSAS CITY KS
66160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1908
  • Fax: 913-588-8387
Mailing address:
  • Phone: 913-588-1908
  • Fax: 913-588-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: