Individual
JAMES BURGESS ANGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTC
Contact information
Practice address
455 W. EATON AVE., TRACY, CA 95376
(209) 830-4062
(209) 839-8316
Mailing address
477 W 22ND ST, TRACY, CA 95376-2544
(925) 667-8018
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
18-0917
CA
Other
Enumeration date
08/30/2019
Last updated
08/30/2019
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