Provider Demographics
NPI:1154708881
Name:ANGEL, LARRY RACASA (PA-C)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:RACASA
Last Name:ANGEL
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:150 SOLANO WAY
Mailing Address - Street 2:CAREONSITE MEDICAL CLINIC AT TESORO
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-1487
Mailing Address - Country:US
Mailing Address - Phone:510-289-3848
Mailing Address - Fax:925-372-0308
Practice Address - Street 1:3400 E. 2ND ST.
Practice Address - Street 2:CAREONSITE, HEALTH SERVICES
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510
Practice Address - Country:US
Practice Address - Phone:707-745-7571
Practice Address - Fax:707-745-7903
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2021-11-08
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Provider Licenses
StateLicense IDTaxonomies
CAPA15911363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical