Provider Demographics
NPI:1295113686
Name:ANGULO, LYDIA CRUZ
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:CRUZ
Last Name:ANGULO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HEBER
Mailing Address - State:CA
Mailing Address - Zip Code:92249-9631
Mailing Address - Country:US
Mailing Address - Phone:760-222-5155
Mailing Address - Fax:760-337-8021
Practice Address - Street 1:41 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:HEBER
Practice Address - State:CA
Practice Address - Zip Code:92249
Practice Address - Country:UM
Practice Address - Phone:760-222-5155
Practice Address - Fax:760-337-8021
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7BDD429343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)