Provider Demographics
NPI:1801070131
Name:ANGELES, KATRINA GO (DDS)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:GO
Last Name:ANGELES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATRINA
Other - Middle Name:GUILATCO
Other - Last Name:GO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8694 N HEARTLAND WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5334
Mailing Address - Country:US
Mailing Address - Phone:559-367-4471
Mailing Address - Fax:
Practice Address - Street 1:6042 N FRESNO ST STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5279
Practice Address - Country:US
Practice Address - Phone:559-457-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA566641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice