Provider Demographics
NPI:1144743857
Name:ISRAEL, ANGEL GABRIEL CASTILLO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANGEL GABRIEL
Middle Name:CASTILLO
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 FACULTY CIR APT D
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3764
Mailing Address - Country:US
Mailing Address - Phone:323-719-7166
Mailing Address - Fax:
Practice Address - Street 1:6915 FACULTY CIRCLE APT. D
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621
Practice Address - Country:US
Practice Address - Phone:323-719-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006987363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner