Individual provider Active NPI

Dominic Matthew Angel

  • Licensed Vocational Nurse
  • Fresno, CA
National Provider Identifier
1578315602
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Vocational NurseTaxonomy code 164X00000X
License
741117 Issued in CA
Practice address
4411 E Cesar Chavez Blvd
Fresno, CA 93702-3604
Phone
(559) 453-1008
NPI assigned
Apr 2, 2024
Last updated
Apr 29, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational Nurse 164X00000X 741117 CA Primary

Addresses

Primary practice location

4411 E Cesar Chavez Blvd
Fresno, CA 93702-3604

Mailing address

3433 W Shaw Ave Ste 108
Fresno, CA 93711-3229

Other practice location 1

496 S Barton Ave
Fresno, CA 93702-2985
Phone (559) 860-4422

Other practice location 2

3147 N Millbrook Ave
Fresno, CA 93703-1425
Phone (559) 453-1008

Other practice location 3

3133B N Millbrook Ave
Fresno, CA 93703-1425
Phone (559) 453-1008

Other practice location 4

3127 N Millbrook Ave
Fresno, CA 93703-1425
Phone (559) 453-1008

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
741117CAMDLicensed Vocational Nurse

NPI Registry JSON

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

{
    "created_epoch": "1712016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1578315602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3433 W SHAW AVE STE 108",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937113229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4411 E CESAR CHAVEZ BLVD",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937023604",
            "telephone_number": "559-453-1008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "496 S Barton Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937022985",
            "country_code": "US",
            "telephone_number": "559-860-4422",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3147 N Millbrook Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937031425",
            "country_code": "US",
            "telephone_number": "559-453-1008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3133B N Millbrook Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937031425",
            "country_code": "US",
            "telephone_number": "559-453-1008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3127 N Millbrook Ave",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937031425",
            "country_code": "US",
            "telephone_number": "559-453-1008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANGEL",
        "first_name": "DOMINIC",
        "middle_name": "MATTHEW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-04-02",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "741117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; 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.