Provider Demographics
NPI:1982774568
Name:CARLOS ARCANGELI MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CARLOS ARCANGELI MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:GUERINO
Authorized Official - Last Name:ARCANGELI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-475-6500
Mailing Address - Street 1:1595 SOQUEL DR
Mailing Address - Street 2:110
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1719
Mailing Address - Country:US
Mailing Address - Phone:831-475-6500
Mailing Address - Fax:831-475-4533
Practice Address - Street 1:1595 SOQUEL DR
Practice Address - Street 2:110
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1719
Practice Address - Country:US
Practice Address - Phone:831-475-6500
Practice Address - Fax:831-475-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG084527208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G84527Medicaid
CAG75132Medicare UPIN
CA00G845270Medicare ID - Type Unspecified