Provider Demographics
NPI:1285853697
Name:GRASSER, ANGELA N (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:N
Last Name:GRASSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S MADERA AVE
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-1750
Mailing Address - Country:US
Mailing Address - Phone:559-846-9370
Mailing Address - Fax:559-846-9354
Practice Address - Street 1:1000 S MADERA AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1750
Practice Address - Country:US
Practice Address - Phone:559-846-9370
Practice Address - Fax:559-846-9354
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A934330Medicare PIN