Provider Demographics
NPI:1467496752
Name:URQUICO, ANGELO S (DPT)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:S
Last Name:URQUICO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E LAMBERT RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4370
Mailing Address - Country:US
Mailing Address - Phone:714-256-5074
Mailing Address - Fax:
Practice Address - Street 1:1800 E LAMBERT RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-256-5074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT32488AMedicare ID - Type Unspecified