Provider Demographics
NPI:1083067441
Name:ANGEL, MAYRA KARINA
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:KARINA
Last Name:ANGEL
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 1:3123 MYRIAM DR
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:TX
Mailing Address - Zip Code:79821-7259
Mailing Address - Country:US
Mailing Address - Phone:915-207-6076
Mailing Address - Fax:
Practice Address - Street 1:3123 MYRIAM DR
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:TX
Practice Address - Zip Code:79821-7259
Practice Address - Country:US
Practice Address - Phone:915-207-6076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX843988163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse