Provider Demographics
NPI:1114229333
Name:ANGAT, ANNA-LIZETTE MATIAS
Entity Type:Individual
Prefix:
First Name:ANNA-LIZETTE
Middle Name:MATIAS
Last Name:ANGAT
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 1:3933 CAPTAIN JON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-5024
Mailing Address - Country:US
Mailing Address - Phone:702-485-1575
Mailing Address - Fax:
Practice Address - Street 1:4215 E BOSTON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5305
Practice Address - Country:US
Practice Address - Phone:702-505-1208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor