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1850 Sullivan Avenue Suite 310 Dalu City CA 94015 | |
(650) 755-3939 | |
(650) 755-3883 |
Full Name | |
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Speciality | Internal Medicine |
Location | 1850 Sullivan Avenue, Dalu City, California |
Authorized Official Name and Position | Hermenegildo G Angeles (PHYSICIAN OWNER) |
Authorized Official Contact | 6502700065 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1850 Sullivan Ave Suite #310 Daly City CA 94015-2221 Ph: (650) 755-3939 | 1850 Sullivan Avenue Suite 310 Dalu City CA 94015 Ph: (650) 755-3939 |
NPI Number | 1528117660 |
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Provider Enumeration Date | 01/09/2007 |
Last Update Date | 06/18/2015 |
Medicare PECOS PAC ID | 0840334181 |
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Medicare Enrollment ID | O20100224000489 |
Identifier | Type | State | Issuer |
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1528117660 | NPI | - | NPPES |
CT956A | Other | CA | MEDICARE PTAN NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | A066103 (California) | Primary |
Provider Name | Hermenegildo Garcia Angeles |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1396712303 PECOS PAC ID: 6305895269 Enrollment ID: I20100224000473 |