Provider Demographics
NPI:1134694946
Name:DEANGELO, ERICA (PA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DEANGELO
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2409 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3207
Mailing Address - Country:US
Mailing Address - Phone:424-400-7722
Mailing Address - Fax:424-400-7721
Practice Address - Street 1:2409 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3207
Practice Address - Country:US
Practice Address - Phone:424-400-7722
Practice Address - Fax:424-400-7721
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA56075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant