Provider Demographics
NPI:1003386764
Name:NILA, ANGELICA HERMELINDA
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:HERMELINDA
Last Name:NILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 MEDINAH CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-9666
Mailing Address - Country:US
Mailing Address - Phone:209-566-5269
Mailing Address - Fax:
Practice Address - Street 1:2617 MEDINAH CT
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-9666
Practice Address - Country:US
Practice Address - Phone:209-566-5269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician