Individual provider Active NPI

Ed G Angulatos, DDS

  • Dentist
  • Rancho Palos Verdes, CA
National Provider Identifier
1003088196
Registry record updated Jun 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
36515 Issued in CA
Practice address
28924 S Western Ave Ste 205
Rancho Palos Verdes, CA 90275
Phone
(310) 832-8309
NPI assigned
Mar 28, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 18, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 36515 CA Primary

Addresses

Primary practice location

28924 S Western Ave Ste 205
Rancho Palos Verdes, CA 90275

Mailing address

28924 S Western Ave Ste 205
Rancho Palos Verdes, CA 90275-0814
Phone (310) 832-8309

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
36515CAMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529280000000",
    "number": "1003088196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28924 S WESTERN AVE STE 205",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "902750814",
            "telephone_number": "310-832-8309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28924 S WESTERN AVE STE 205",
            "city": "RANCHO PALOS VERDES",
            "state": "CA",
            "postal_code": "90275",
            "telephone_number": "310-832-8309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANGULATOS",
        "first_name": "ED",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-03-28",
        "last_updated": "2018-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "36515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Palos Verdes, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.