Provider Demographics
NPI:1275578965
Name:CRUDALE, ANGELO (MD)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:CRUDALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG383302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G3833021Medicare PIN
CA300114843Medicare PIN
CAA47447Medicare UPIN
CAP00458268Medicare PIN
CA00G3833015Medicare PIN
CA00G383303Medicare PIN
CA00G3833011Medicare PIN
CA00G3833012Medicare PIN
CA00G3833016Medicare PIN
CA00G3833018Medicare PIN
CA300124999Medicare PIN
CA00G3833010Medicare PIN
CA00G383308Medicare PIN
CA00G383302Medicare PIN
CA00G3833020Medicare PIN
CA00G383300Medicare PIN
CA00G3833017Medicare PIN
CA00G3833019Medicare PIN
CA00G383305Medicare PIN
CA00G383309Medicare PIN