Provider Demographics
NPI:1225211626
Name:ANGULO, GERARDO L (MED CACII)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:L
Last Name:ANGULO
Suffix:
Gender:M
Credentials:MED CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8931 HURON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260
Mailing Address - Country:US
Mailing Address - Phone:303-264-8648
Mailing Address - Fax:303-853-3735
Practice Address - Street 1:8931 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260
Practice Address - Country:US
Practice Address - Phone:303-264-8648
Practice Address - Fax:303-853-3735
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6609101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor