Provider Demographics
NPI:1659303873
Name:ANGSTREICH, GREG R (MD)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:R
Last Name:ANGSTREICH
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:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:949-646-6441
Mailing Address - Fax:949-646-5719
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-646-6441
Practice Address - Fax:949-646-5719
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54662207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001423938Medicaid
CT900000029Medicare ID - Type Unspecified
G95295Medicare UPIN