Provider Demographics
NPI:1962403493
Name:HERRMANN, ANGELA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LYNN
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:630 S GLASSELL ST
Mailing Address - Street 2:SUITE 106-A
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3004
Mailing Address - Country:US
Mailing Address - Phone:714-639-9691
Mailing Address - Fax:714-639-6580
Practice Address - Street 1:630 S GLASSELL ST
Practice Address - Street 2:SUITE 106-A
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-3004
Practice Address - Country:US
Practice Address - Phone:714-639-9691
Practice Address - Fax:714-639-6580
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA75988208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A759880Medicaid