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1972564672 NPI number — JUAN D. ANGULO D.D.S.

NPI Number: 1972564672
Health Care Provider/Practitioner: JUAN D. ANGULO D.D.S.

Information about “1972564672” NPI (JUAN D. ANGULO D.D.S.) exists in 1972564672 in HTML format HTML  |  1972564672 in plain Text format TXT  |  1972564672 in PDF (Portable Document Format) PDF  |  1972564672 in an XML format XML  formats.

NPI Number : 1972564672 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972564672",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ANGULO",
    "FirstName": "JUAN",
    "MiddleName": "D.",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "D.D.S.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ANGULO",
    "OtherFirstName": "JUAN",
    "OtherMiddleName": "D.",
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": null,
    "OtherCredential": "D.D.S.",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "41680 IVY STREET, SUITE C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MURRIETA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92562",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "951-304-0877",
    "MailingAddressFaxNumber": "951-304-0896",
    "FirstLinePracticeLocationAddress": "41680 IVY STREET, SUITE C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MURRIETA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92562",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "951-304-0877",
    "PracticeLocationAddressFaxNumber": "951-304-0896",
    "EnumerationDate": "03/31/2006",
    "LastUpdateDate": "11/20/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1223G0001X",
          "TaxonomyName": "General Practice Dentistry",
          "LicenseNumber": "44453",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "44453",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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