Provider Demographics
NPI:1760550198
Name:ANGEL, STEPHEN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PAUL
Last Name:ANGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 SUPERIOR AVE
Mailing Address - Street 2:320
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2716
Mailing Address - Country:US
Mailing Address - Phone:949-645-8475
Mailing Address - Fax:949-645-0116
Practice Address - Street 1:320 SUPERIOR AVE
Practice Address - Street 2:320
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2716
Practice Address - Country:US
Practice Address - Phone:949-645-8475
Practice Address - Fax:949-645-0116
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG30448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG30448Medicare ID - Type Unspecified
A91286Medicare UPIN