Provider Demographics
NPI:1144592247
Name:DEANGELIS, MATTHEW (NP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 SANTIAGO AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3332
Mailing Address - Country:US
Mailing Address - Phone:650-444-3182
Mailing Address - Fax:
Practice Address - Street 1:2575 SAND HILL RD
Practice Address - Street 2:MS# 25
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-7015
Practice Address - Country:US
Practice Address - Phone:650-926-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA633583163W00000X
CA21084363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
No163W00000XNursing Service ProvidersRegistered Nurse