Provider Demographics
NPI:1477562486
Name:KAISARIEH, ANGELINA (MD)
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:KAISARIEH
Suffix:
Gender:F
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:PO BOX 1434
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-1434
Mailing Address - Country:US
Mailing Address - Phone:209-462-7277
Mailing Address - Fax:866-950-0134
Practice Address - Street 1:123 S COMMERCE ST
Practice Address - Street 2:SUITE D
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2837
Practice Address - Country:US
Practice Address - Phone:209-467-6825
Practice Address - Fax:209-467-6827
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine