Provider Demographics
NPI:1992401038
Name:CONCEPCION, MARIA ANGELICA SANTOS
Entity type:Individual
Prefix:
First Name:MARIA ANGELICA
Middle Name:SANTOS
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231914
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-1914
Mailing Address - Country:US
Mailing Address - Phone:760-456-9688
Mailing Address - Fax:
Practice Address - Street 1:477 N EL CAMINO REAL STE A200
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1350
Practice Address - Country:US
Practice Address - Phone:858-766-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant