Provider Demographics
NPI:1073365458
Name:LOUANGPRASERT, ANGELIQUE ACHACOSO (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:ACHACOSO
Last Name:LOUANGPRASERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 W PALMAIRE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-6906
Mailing Address - Country:US
Mailing Address - Phone:623-203-9779
Mailing Address - Fax:
Practice Address - Street 1:5601 W EUGIE AVE STE 204
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1258
Practice Address - Country:US
Practice Address - Phone:623-244-0050
Practice Address - Fax:833-623-1832
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical