Provider Demographics
NPI:1447931167
Name:EULOGIO-ANGEL, SERGIO
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:EULOGIO-ANGEL
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 1:1960 S MCCLELLAND ST APT 36
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7826
Mailing Address - Country:US
Mailing Address - Phone:805-332-0392
Mailing Address - Fax:
Practice Address - Street 1:201 W CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4303
Practice Address - Country:US
Practice Address - Phone:805-964-8857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker