Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1609367242 |
---|---|
Provider Name | Ricardo Angeles |
First Address | Beverly Hills, CA 90210-4340 |
Second Address | Beverly Hills, CA 90210-4340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2018 |
Last Update Date | 18/05/2018 |