Provider Demographics
NPI:1578526521
Name:PALANCA-CAPISTRANO, ANGELITA MARQUINEZ (MD)
Entity Type:Individual
Prefix:
First Name:ANGELITA
Middle Name:MARQUINEZ
Last Name:PALANCA-CAPISTRANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELITA
Other - Middle Name:PALANCA
Other - Last Name:CAPISTRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:19069 VAN BUREN BLVD STE 114-219
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9169
Mailing Address - Country:US
Mailing Address - Phone:951-372-9227
Mailing Address - Fax:951-372-9005
Practice Address - Street 1:720 MAGNOLIA AVE
Practice Address - Street 2:SUITE A-4
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3119
Practice Address - Country:US
Practice Address - Phone:951-372-9227
Practice Address - Fax:951-372-9005
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91568207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91568OtherMEDICAL BOARD OF CA LICEN
CA1585438Medicaid
CABP9270238OtherDEA REGISTRATION
CAA91568OtherMEDICAL BOARD OF CA LICEN