Provider Demographics
NPI:1992228779
Name:WARREN G ANSALDO OD, APC
Entity type:Organization
Organization Name:WARREN G ANSALDO OD, APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:GALANG
Authorized Official - Last Name:ANSALDO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-689-4332
Mailing Address - Street 1:10957 KNOXVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5289
Mailing Address - Country:US
Mailing Address - Phone:949-689-4332
Mailing Address - Fax:
Practice Address - Street 1:7038 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-2805
Practice Address - Country:US
Practice Address - Phone:714-895-4899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicaid