Provider Demographics
NPI:1073543054
Name:ANGELES, MARIA VICTORIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:ANGELES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 E EUREKA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086
Mailing Address - Country:US
Mailing Address - Phone:817-599-4901
Mailing Address - Fax:817-599-4902
Practice Address - Street 1:907 E EUREKA ST
Practice Address - Street 2:SUITE B
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086
Practice Address - Country:US
Practice Address - Phone:817-599-4901
Practice Address - Fax:817-599-4902
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04455363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y1585OtherBCBS
TX8J4902Medicare UPIN