Provider Demographics
NPI:1104886753
Name:NAZARENO, ANGELO JOCO (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:JOCO
Last Name:NAZARENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8118 TIMBERLAKE WAY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5400
Mailing Address - Country:US
Mailing Address - Phone:916-688-5040
Mailing Address - Fax:916-688-7866
Practice Address - Street 1:8118 TIMBERLAKE WAY
Practice Address - Street 2:SUITE 230
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5400
Practice Address - Country:US
Practice Address - Phone:916-688-5040
Practice Address - Fax:916-688-7866
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45071208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A45071Medicaid
CAE17178Medicare UPIN