Basic Information
| Provider Information | |||||||||
| NPI: | 1932610052 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGEL | ||||||||
| FirstName: | RAUL | ||||||||
| MiddleName: | ESPINOSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 S KENNETH AVE | ||||||||
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| City: | KERMAN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936309369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592594637 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4411 E KINGS CANYON RD # 319 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937023604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596002382 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2017 | ||||||||
| LastUpdateDate: | 05/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | 38161 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.