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General NPI Number Information
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NPI Number | 1134574783
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Entity Type | Individual
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Provider Name | WARREN G ANSALDO O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 7038 KATELLA AVE
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City | STANTON
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State | CA
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Zip | 90680-2805
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Country | US
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Telephone | 714-895-4899
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Fax |
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Provider Business Mailing Address
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Address Line | 798 SAINT JAMES DR
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City | CORONA
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State | CA
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Zip | 92882-8829
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Country | US
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Telephone | 949-689-4332
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT33418TLG
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 33418TLG
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License Number State | CA
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