Provider Demographics
NPI:1467837971
Name:CANGO, CRISENCIANO ANGELO PANES
Entity Type:Individual
Prefix:MR
First Name:CRISENCIANO ANGELO
Middle Name:PANES
Last Name:CANGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 W SAMPLE RD APT 304
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3268
Mailing Address - Country:US
Mailing Address - Phone:325-203-0351
Mailing Address - Fax:
Practice Address - Street 1:1801 SLAYDEN ST APT 7
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5522
Practice Address - Country:US
Practice Address - Phone:325-203-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-26
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2110137225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant