Provider Demographics
NPI:1548782584
Name:ANGEL, HENRY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:ANGEL
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 1:5403 W WESTBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1855
Mailing Address - Country:US
Mailing Address - Phone:210-396-8562
Mailing Address - Fax:
Practice Address - Street 1:5403 W WESTBERRY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1855
Practice Address - Country:US
Practice Address - Phone:210-396-8562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 363A00000X
TX2404172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant