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General NPI Number Information
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NPI Number | 1891993192
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Entity Type | Individual
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Provider Name | LISA ANN DEANGELIS MD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2007
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 220 KENNEDY DR
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City | TORRINGTON
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State | CT
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Zip | 06790-7204
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Country | US
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Telephone | 860-482-8578
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Fax |
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Provider Business Mailing Address
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Address Line | 1 QUALITY DR
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City | VACAVILLE
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State | CA
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Zip | 95688-9494
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Country | US
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Telephone | 707-624-3800
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Fax | 707-624-4382
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | C171657
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License Number State | CA
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