Provider Demographics
NPI:1275896227
Name:CANGCO, ELLEN CALLUENG (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:CALLUENG
Last Name:CANGCO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:ELLEN
Other - Middle Name:CALLUENG
Other - Last Name:CANGCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8026 SEMINARIO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-5177
Mailing Address - Country:US
Mailing Address - Phone:210-522-9779
Mailing Address - Fax:210-522-9779
Practice Address - Street 1:7400 MERTON MINTER ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:210-949-3884
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-23
Last Update Date:2012-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX682787163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse