Provider Demographics
NPI:1407195696
Name:BADILLO, ANGELICA (RN)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:BADILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:208 PASEO TAMEX
Mailing Address - Street 2:
Mailing Address - City:RIO RICO
Mailing Address - State:AZ
Mailing Address - Zip Code:85648-1041
Mailing Address - Country:US
Mailing Address - Phone:520-860-0262
Mailing Address - Fax:520-375-8690
Practice Address - Street 1:1374 W FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:RIO RICO
Practice Address - State:AZ
Practice Address - Zip Code:85648-6377
Practice Address - Country:US
Practice Address - Phone:520-375-8600
Practice Address - Fax:520-375-8690
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN170757163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool