Provider Demographics
NPI:1396712303
Name:ANGELES, HERMENEGILDO G JR (MD APC)
Entity type:Individual
Prefix:DR
First Name:HERMENEGILDO
Middle Name:G
Last Name:ANGELES
Suffix:JR
Gender:M
Credentials:MD APC
Other - Prefix:DR
Other - First Name:HERMENEGILDO
Other - Middle Name:G
Other - Last Name:ANGELES
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD APC
Mailing Address - Street 1:1850 SULLIVAN AVE
Mailing Address - Street 2:SUITE #310
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2221
Mailing Address - Country:US
Mailing Address - Phone:650-755-3939
Mailing Address - Fax:650-755-3883
Practice Address - Street 1:1850 SULLIVAN AVE
Practice Address - Street 2:SUITE #310
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2221
Practice Address - Country:US
Practice Address - Phone:650-755-3939
Practice Address - Fax:650-755-3883
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066103207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACT957ZOtherMEDICARE PTAN
G87972Medicare UPIN