Provider Demographics
NPI:1730258229
Name:ORNELAS, RICHARD ANGEL
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANGEL
Last Name:ORNELAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 S WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2930
Mailing Address - Country:US
Mailing Address - Phone:408-866-4000
Mailing Address - Fax:408-866-3999
Practice Address - Street 1:828 S WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2930
Practice Address - Country:US
Practice Address - Phone:408-866-4000
Practice Address - Fax:408-866-3999
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG065986207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE7547Medicare UPIN
CA00G659860Medicare ID - Type Unspecified