Provider Demographics
NPI:1093420804
Name:RANGEL, CAESAR FERNANDO (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CAESAR
Middle Name:FERNANDO
Last Name:RANGEL
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 N DREAMY DRAW DR STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4668
Mailing Address - Country:US
Mailing Address - Phone:480-882-4545
Mailing Address - Fax:602-409-0499
Practice Address - Street 1:11851 N 51ST AVE STE F140
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2847
Practice Address - Country:US
Practice Address - Phone:480-882-4545
Practice Address - Fax:602-409-0499
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ285931363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ285931OtherARIZONA APRN-RNP LICENSE
AZ145026Medicaid