Provider Demographics
NPI:1821093394
Name:ARCILLA, ANGELO C (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:C
Last Name:ARCILLA
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SULLIVAN AVE
Mailing Address - Street 2:RM 101
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2227
Mailing Address - Country:US
Mailing Address - Phone:650-994-0459
Mailing Address - Fax:650-994-1450
Practice Address - Street 1:1800 SULLIVAN AVE
Practice Address - Street 2:RM 101
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2227
Practice Address - Country:US
Practice Address - Phone:650-994-0459
Practice Address - Fax:650-994-1450
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2010-01-26
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
CAA048557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A485572Medicaid
CA00A485572Medicaid
CAF26258Medicare UPIN