Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 36515 | CA |
NPI | 1003088196 |
---|---|
Provider Name | Dr. Ed G Angulatos |
First Address | Rancho Palos Verdes, CA 90275-0814 |
Second Address | Rancho Palos Verdes, CA 90275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2008 |
Last Update Date | 18/06/2018 |