Provider Demographics
NPI:1467054031
Name:ANGULO, LUZ M (RDHAP)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:M
Last Name:ANGULO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45549 JAGUAR WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6892
Mailing Address - Country:US
Mailing Address - Phone:619-313-3119
Mailing Address - Fax:
Practice Address - Street 1:45549 JAGUAR WAY
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6892
Practice Address - Country:US
Practice Address - Phone:619-313-3119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA806124Q00000X
CA28025124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist