Provider Demographics
NPI:1376911263
Name:ANGULO, MARIO ULISES (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ULISES
Last Name:ANGULO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 N SILVERBELL RD
Mailing Address - Street 2:SUITE 265
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2675
Mailing Address - Country:US
Mailing Address - Phone:520-624-2194
Mailing Address - Fax:520-624-2193
Practice Address - Street 1:1895 W VALENCIA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6555
Practice Address - Country:US
Practice Address - Phone:520-576-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant