Provider Demographics
NPI:1144684036
Name:FENG, ANGELA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:FENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 S COUNTRY CLUB DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6044
Mailing Address - Country:US
Mailing Address - Phone:480-827-5500
Mailing Address - Fax:480-827-5575
Practice Address - Street 1:1950 S COUNTRY CLUB DR STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6044
Practice Address - Country:US
Practice Address - Phone:480-827-5500
Practice Address - Fax:480-827-5575
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine