Provider Demographics
NPI:1093212623
Name:PASCUA, ANGELA MARIE (NONE)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:PASCUA
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:PO BOX 2219
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92244-2219
Mailing Address - Country:US
Mailing Address - Phone:760-353-6922
Mailing Address - Fax:760-353-8372
Practice Address - Street 1:510 W MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2900
Practice Address - Country:US
Practice Address - Phone:760-353-6922
Practice Address - Fax:760-353-8372
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator