Provider Demographics
NPI:1346328721
Name:RENDON, ANGEL (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:RENDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W CAMERON AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2726
Mailing Address - Country:US
Mailing Address - Phone:626-337-8811
Mailing Address - Fax:626-856-5653
Practice Address - Street 1:1515 W CAMERON AVE STE 350
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2726
Practice Address - Country:US
Practice Address - Phone:626-337-8811
Practice Address - Fax:626-856-5653
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA400562084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry