Provider Demographics
NPI:1235195256
Name:ANGUS, THEODORE J (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:J
Last Name:ANGUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THEODORE
Other - Middle Name:JAMES
Other - Last Name:ANGUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11980
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-1980
Mailing Address - Country:US
Mailing Address - Phone:877-344-0508
Mailing Address - Fax:562-468-0347
Practice Address - Street 1:1306 MARICOPA HIGHWAY
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023
Practice Address - Country:US
Practice Address - Phone:805-646-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30139207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G301390Medicaid
CAWG30139JMedicare PIN
CA00G301390Medicaid