Provider Demographics
NPI:1053000224
Name:ANGSTROM, PRESTON RAY
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:RAY
Last Name:ANGSTROM
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 1:22132 CAMINITO TASQUILLO
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1182
Mailing Address - Country:US
Mailing Address - Phone:949-910-5953
Mailing Address - Fax:
Practice Address - Street 1:3140 RED HILL AVE STE 225
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3440
Practice Address - Country:US
Practice Address - Phone:714-557-2100
Practice Address - Fax:714-557-2111
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50309225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant