Individual provider Active NPI

Guillermo Roberto De Angulo, MD

  • Pediatric Hematology & Oncology Physician
  • Miami, FL
National Provider Identifier
1679791370
Registry record updated Apr 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
ME98389 Issued in FL
Practice address
3100 SW 62ND Avenue
NE Wing, Suite 121
Miami, FL 33155
Phone
(305) 662-8360
NPI assigned
Apr 20, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 30, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hematology & Oncology Physician 2080P0207X ME 08389 FL
Pediatric Hematology & Oncology Physician 2080P0207X ME98389 FL Primary

Addresses

Primary practice location

3100 SW 62ND Avenue
NE Wing, Suite 121
Miami, FL 33155

Mailing address

5955 Ponce de Leon Blvd
Coral Gables, FL 33146
Phone (305) 661-1515

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150617000379 FL Practitioner - Pediatric MedicinePractitioner - HematologyPractitioner - Hematology/Oncology 6800107962 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Hematology/Oncology
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kidz Medical Services IncGroup PAC ID 3678536240, 24 clinicians

Practice addresses (Care Compare)

5955 Ponce de Leon Blvd
Coral Gables, FL 33146-2423
Phone 3056611515243

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME 08389FLMDPediatric Hematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kidz Medical Services, Inc CurrentSince Nov 23, 2014 Accepting new patients
Kidz Medical Services, Inc Pediatric Hematology-Oncology CurrentSince Nov 23, 2014 Accepting new patients

Locations

9980 Central Park Blvd N
Ste 318
Boca Raton, FL 33428
Phone (561) 451-0500

5955 Ponce de Leon Blvd
Coral Gables, FL 33146
Phone (305) 662-8668

975 Baptist Way
Ste 203
Homestead, FL 33033
Phone (305) 242-8200

3100 SW 62nd Ave
Ste 121
Miami, FL 33155
Phone (305) 662-8360

Interoperability endpoints

  • Direct secure messaging: guillermo.de.angulo.1@27004.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367280000000",
    "number": "1679791370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5955 PONCE DE LEON BLVD",
            "city": "CORAL GABLES",
            "state": "FL",
            "postal_code": "33146",
            "telephone_number": "305-661-1515",
            "fax_number": "305-662-3723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SW 62ND AVENUE",
            "address_2": "NE WING, SUITE 121",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "33155",
            "telephone_number": "305-662-8360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE ANGULO",
        "first_name": "GUILLERMO",
        "middle_name": "ROBERTO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2013-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "FL",
            "license": "ME 08389",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "FL",
            "license": "ME98389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.