Provider Demographics
NPI:1598320335
Name:HALL, ANGELICA ZHANE
Entity Type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:ZHANE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W OWENS AVE APT 119
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-1404
Mailing Address - Country:US
Mailing Address - Phone:702-418-2144
Mailing Address - Fax:
Practice Address - Street 1:21 W OWENS AVE APT 119
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-1404
Practice Address - Country:US
Practice Address - Phone:702-418-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health