Provider Demographics
NPI:1528179470
Name:ANGIOLI, MICHAEL D (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:ANGIOLI
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Gender:M
Credentials:PHD
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Mailing Address - Street 1:30011 IVY GLENN DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5014
Mailing Address - Country:US
Mailing Address - Phone:949-249-8734
Mailing Address - Fax:949-249-7780
Practice Address - Street 1:30011 IVY GLENN DR
Practice Address - Street 2:SUITE 205
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5014
Practice Address - Country:US
Practice Address - Phone:949-249-8734
Practice Address - Fax:949-249-7780
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 9684103TC0700X
HIPSY 621103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0728538OtherEIN #
CACP9684Medicare ID - Type UnspecifiedPSYCHOLOGIST