Provider Demographics
NPI:1417068172
Name:FARELLA, ANGELINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELINA
Middle Name:
Last Name:FARELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 SAN PEDRO AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4361
Mailing Address - Country:US
Mailing Address - Phone:210-281-8669
Mailing Address - Fax:210-314-5044
Practice Address - Street 1:17323 IH 35 N
Practice Address - Street 2:STE 113
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1277
Practice Address - Country:US
Practice Address - Phone:210-543-7334
Practice Address - Fax:210-314-5044
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7016208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF0109984OtherTX DEPT OF PUBLIC SAFETY
TXK7016OtherLICENSE
TXK7016OtherLICENSE
G8598Medicare UPIN