Provider Demographics
NPI:1982880118
Name:ANGEL MEDICAL GROUP, INC
Entity type:Organization
Organization Name:ANGEL MEDICAL GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/OPERATIONS CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:SIEMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-219-3799
Mailing Address - Street 1:2372 SE BRISTOL ST
Mailing Address - Street 2:STE B
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0755
Mailing Address - Country:US
Mailing Address - Phone:888-975-3246
Mailing Address - Fax:909-235-4145
Practice Address - Street 1:2372 SE BRISTOL ST
Practice Address - Street 2:STE B
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0755
Practice Address - Country:US
Practice Address - Phone:888-975-3246
Practice Address - Fax:909-235-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty