Provider Demographics
NPI:1760747299
Name:ANGELES, MARVIN ESGUERRA (PT)
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:ESGUERRA
Last Name:ANGELES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3739
Mailing Address - Country:US
Mailing Address - Phone:707-217-4388
Mailing Address - Fax:
Practice Address - Street 1:3270 BENTON ST
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-3739
Practice Address - Country:US
Practice Address - Phone:707-217-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 29388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist