Provider Demographics
NPI:1659464485
Name:RANGEL, DECIO DEMOURA (MD)
Entity type:Individual
Prefix:DR
First Name:DECIO
Middle Name:DEMOURA
Last Name:RANGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:#780W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-828-7454
Mailing Address - Fax:310-828-6362
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:#780W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-828-7454
Practice Address - Fax:310-828-6362
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25197208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25197Medicare ID - Type Unspecified
B50006Medicare UPIN