Individual
MR. ANGEL PEMAYUN ANAK-AGUNG-GEDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5717 PACIFIC CENTER BLVD STE 200, SAN DIEGO, CA 92121-4250
(858) 859-1188
(844) 404-8924
Mailing address
5717 PACIFIC CENTER BLVD STE 200, SAN DIEGO, CA 92121-4250
(858) 859-1188
(844) 404-8924
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA19498
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19498
STATE LICENSE
CA
Enumeration date
09/28/2009
Last updated
05/08/2019
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