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General NPI Number Information
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NPI Number | 1508523416
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Entity Type | Individual
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Provider Name | MATTHEW TIMOTHY ANGQUICO
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Gender | Male
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Dates
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Enumeration Date | 11/26/2021
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Last Update Date | 11/26/2021
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Provider Practice Location Address
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Address Line | 9532 WINTER GARDENS BLVD
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City | LAKESIDE
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State | CA
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Zip | 92040-4032
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Country | US
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Telephone | 619-390-7342
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Fax |
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Provider Business Mailing Address
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Address Line | 13217 AURORA DR SPC 46
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City | EL CAJON
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State | CA
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Zip | 92021-1813
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Country | US
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Telephone | 619-633-5900
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 178781
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License Number State | CA
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