Provider Demographics
NPI:1861512386
Name:SAL C SANTANGELO, A PROF CORP
Entity Type:Organization
Organization Name:SAL C SANTANGELO, A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANTANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-983-0707
Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:SUITE 470
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3790
Mailing Address - Country:US
Mailing Address - Phone:805-983-0707
Mailing Address - Fax:805-983-0334
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:SUITE 470
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3790
Practice Address - Country:US
Practice Address - Phone:805-983-0707
Practice Address - Fax:805-983-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33564208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty