Angela Iskandar Anak-Agung-Gede, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

19998 Issued in CA

Practice address

480 4TH Avenue
Suite 307
Chula Vista, CA 91910

Phone

(619) 426-3240

Fax

(619) 426-5964

NPI assigned

Jun 12, 2009

Last updated

Sep 20, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Angela Gracia Iskandar Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1244764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316476800000",
    "number": "1790912103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 4TH AVENUE",
            "address_2": "SUITE 307",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "91910",
            "telephone_number": "619-426-3240",
            "fax_number": "619-426-5964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 4TH AVENUE",
            "address_2": "SUITE 307",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "91910",
            "telephone_number": "619-426-3240",
            "fax_number": "619-426-5964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANAK-AGUNG-GEDE",
        "first_name": "ANGELA",
        "middle_name": "ISKANDAR",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-12",
        "last_updated": "2011-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "19998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "19998",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "ISKANDAR",
            "middle_name": "GRACIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Gillene Amoguis
• Heidi Marie Amundson, PA-C
• Ana Meigs, D.D.S. (Meigs Family Dental)
• Christopher Edward Anable
• Rosalia Anacleto
• Willy Anand, MD
• Khamara Anders
• Angela Andersen, PTA
• Alexis Anderson
• Brian Cornell Anderson, M.D.

• Medical Physician Assistant in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; 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.