Provider Demographics
NPI:1689699530
Name:ANGELES, ESPERANZA SAN MIGUEL (MD)
Entity Type:Individual
Prefix:
First Name:ESPERANZA
Middle Name:SAN MIGUEL
Last Name:ANGELES
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 1:556 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5611
Mailing Address - Country:US
Mailing Address - Phone:718-784-4178
Mailing Address - Fax:718-784-4757
Practice Address - Street 1:556 49TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5611
Practice Address - Country:US
Practice Address - Phone:718-784-4178
Practice Address - Fax:718-784-4757
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11705Medicare UPIN