Individual
MRS. TEODORICA M ANGULO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDO
Contact information
Practice address
459 S AZUSA AVE STE F, AZUSA, CA 91702-4945
(626) 969-7538
(626) 969-7538
Mailing address
459 S AZUSA AVE STE F, AZUSA, CA 91702-4945
(626) 969-7538
(626) 969-7538
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
3994
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2361519
OPTICAL DISPENSER PROVIDE
CA
Enumeration date
10/24/2006
Last updated
07/08/2007
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