Active NPI
James Burgess Angel, OTC
- Other Technician
- Tracy, CA
National Provider Identifier
1932757150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 18-0917
- Practice address
- 455 W. Eaton Ave.
Tracy, CA 95376 - Phone
- (209) 830-4062
- Fax
- (209) 839-8316
- NPI assigned
- Aug 30, 2019
- Last updated
- Aug 30, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 18-0917 | CA | Primary |
Addresses
Primary practice location
455 W. Eaton Ave.
Tracy, CA 95376
Mailing address
477 W 22ND St
Tracy, CA 95376-2544
Phone (925) 667-8018
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
| License | State | Type | Specialty |
|---|---|---|---|
| 18-0917 | CA | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567123200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567123200000",
"number": "1932757150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "477 W 22ND ST",
"city": "TRACY",
"state": "CA",
"postal_code": "953762544",
"telephone_number": "925-667-8018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "455 W. EATON AVE.",
"city": "TRACY",
"state": "CA",
"postal_code": "95376",
"telephone_number": "209-830-4062",
"fax_number": "209-839-8316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANGEL",
"first_name": "JAMES",
"middle_name": "BURGESS",
"credential": "OTC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-30",
"last_updated": "2019-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "CA",
"license": "18-0917",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tracy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.