MEDICARE: ANGEL RENDON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	A40056	CA

General Provider Information

NPI Number	:	1346328721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL RENDON M.D.

Provider Business Mailing Address
First Line	:	1515 W CAMERON AVE STE 350
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-2726
Country	:	US
Telephone Number	:	626-337-8811
Fax Number	:	626-856-5653

Provider Business Practice Location Address
First Line	:	1515 W CAMERON AVE STE 350
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-2726
Country	:	US
Telephone Number	:	626-337-8811
Fax Number	:	626-856-5653

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/19/2021

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