Individual
ANGELA ISKANDAR ANAK-AGUNG-GEDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
480 4TH AVENUE, SUITE 307, CHULA VISTA, CA 91910
(619) 426-3240
(619) 426-5964
Mailing address
480 4TH AVENUE, SUITE 307, CHULA VISTA, CA 91910
(619) 426-3240
(619) 426-5964
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
19998
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19998
STATE LICENSE
CA
Enumeration date
06/12/2009
Last updated
09/20/2011
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