Provider Demographics
NPI:1962739896
Name:EDUARDO E ANGUIZOLA M.D., INC
Entity type:Organization
Organization Name:EDUARDO E ANGUIZOLA M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-543-2554
Mailing Address - Street 1:PO BOX 3848
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-3848
Mailing Address - Country:US
Mailing Address - Phone:714-873-2554
Mailing Address - Fax:714-835-1383
Practice Address - Street 1:1200 N TUSTIN AVE STE 255
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6500
Practice Address - Country:US
Practice Address - Phone:714-873-2554
Practice Address - Fax:714-835-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37952208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA28494Medicare UPIN
CAA37952CMedicare PIN