Provider Demographics
NPI:1639546971
Name:ANGEL, MABEL (LAC,)
Entity Type:Individual
Prefix:MRS
First Name:MABEL
Middle Name:
Last Name:ANGEL
Suffix:
Gender:F
Credentials:LAC,
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:109 FAIRFIELD WAY # EAY
Mailing Address - Street 2:104
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1583
Mailing Address - Country:US
Mailing Address - Phone:630-300-3878
Mailing Address - Fax:630-924-0599
Practice Address - Street 1:109 FAIRFIELD WAY # EAY
Practice Address - Street 2:104
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1583
Practice Address - Country:US
Practice Address - Phone:630-300-3878
Practice Address - Fax:630-924-0599
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL198.001262171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist