Provider Demographics
NPI:1548275365
Name:ITURIAGA, ANGELINE YATAR (MD)
Entity type:Individual
Prefix:
First Name:ANGELINE
Middle Name:YATAR
Last Name:ITURIAGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S BEACH BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1812
Mailing Address - Country:US
Mailing Address - Phone:714-952-4147
Mailing Address - Fax:714-952-2620
Practice Address - Street 1:515 S BEACH BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1812
Practice Address - Country:US
Practice Address - Phone:714-952-4147
Practice Address - Fax:714-952-2620
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30865208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A308650OtherMEDICAL