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General NPI Number Information
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NPI Number | 1134206436
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Entity Type | Organization
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Legal Business Name | ANGEL FAMILY PRACTICE MEDICAL GROUP INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 2015 E FLORENCE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90001-2754
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Country | US
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Telephone | 323-581-0000
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Fax | 323-585-4030
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Provider Business Mailing Address
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Address Line | 5340 LA FIESTA
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City | YORBA LINDA
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State | CA
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Zip | 92887-4009
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Country | US
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Telephone | 714-692-5775
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAHENDRA G SANATHRA
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Credential | M.D.
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Telephone | 323-581-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A50182
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License Number State | CA
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