Provider Demographics
NPI:1265997233
Name:ANG, ATLAS APIQUE (PT)
Entity type:Individual
Prefix:
First Name:ATLAS
Middle Name:APIQUE
Last Name:ANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12903 RAMSEY DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1746
Mailing Address - Country:US
Mailing Address - Phone:562-296-7121
Mailing Address - Fax:
Practice Address - Street 1:12903 RAMSEY DR
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1746
Practice Address - Country:US
Practice Address - Phone:562-296-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist