Provider Demographics
NPI:1972664183
Name:SANTANGELO, SAL C (MD)
Entity Type:Individual
Prefix:
First Name:SAL
Middle Name:C
Last Name:SANTANGELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 LA PATERA CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8412
Mailing Address - Country:US
Mailing Address - Phone:805-482-6400
Mailing Address - Fax:805-482-3068
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:STE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33564208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G335640Medicaid
G33564Medicare ID - Type Unspecified
CA00G335640Medicaid