Provider Demographics
NPI:1598711319
Name:ANGELOW, ANGEL GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:GEORGE
Last Name:ANGELOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3255
Mailing Address - Country:US
Mailing Address - Phone:310-241-2590
Mailing Address - Fax:
Practice Address - Street 1:1499 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3255
Practice Address - Country:US
Practice Address - Phone:310-241-2590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A491250Medicaid
CA00A491250Medicaid
CAWA49125GMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CA00A491250Medicaid