Provider Demographics
NPI:1619982311
Name:DUENAS, ANGELICA (MD)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:DUENAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 WASHINGTON BLVD
Mailing Address - Street 2:SUITE # 825
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5421
Mailing Address - Country:US
Mailing Address - Phone:310-600-2787
Mailing Address - Fax:310-306-4852
Practice Address - Street 1:578 WASHINGTON BLVD
Practice Address - Street 2:SUITE # 825
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5421
Practice Address - Country:US
Practice Address - Phone:310-600-2787
Practice Address - Fax:310-306-4852
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine