Provider Demographics
NPI:1538830765
Name:MAGDANGAL, GILAN ANGELES (NP)
Entity type:Individual
Prefix:
First Name:GILAN
Middle Name:ANGELES
Last Name:MAGDANGAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11721 VALE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-8357
Mailing Address - Country:US
Mailing Address - Phone:909-997-0219
Mailing Address - Fax:
Practice Address - Street 1:5365 WALNUT AVE STE A
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2622
Practice Address - Country:US
Practice Address - Phone:909-902-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily