Provider Demographics
NPI:1922240258
Name:ANGELA HERRMANN MD, INC
Entity Type:Organization
Organization Name:ANGELA HERRMANN MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-639-9691
Mailing Address - Street 1:630 S GLASSELL ST
Mailing Address - Street 2:SUITE 106A
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3004
Mailing Address - Country:US
Mailing Address - Phone:714-639-9691
Mailing Address - Fax:714-639-6580
Practice Address - Street 1:630 S GLASSELL ST
Practice Address - Street 2:SUITE 106A
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3004
Practice Address - Country:US
Practice Address - Phone:714-639-9691
Practice Address - Fax:714-639-6580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75988208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty