Provider Demographics
NPI:1275927238
Name:DELOSANGELES, ERNEST ANTHONY JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:ANTHONY
Last Name:DELOSANGELES
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 N SAN JOSE ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5037
Mailing Address - Country:US
Mailing Address - Phone:209-607-7035
Mailing Address - Fax:
Practice Address - Street 1:2220 N SAN JOSE ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5037
Practice Address - Country:US
Practice Address - Phone:209-607-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer