Provider Demographics
NPI:1760771067
Name:ANGUIANO, KRISTAL (PA)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:ANGUIANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 158
Mailing Address - Street 2:EL CENTRO FAMILY HEALTH
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-0158
Mailing Address - Country:US
Mailing Address - Phone:505-753-7218
Mailing Address - Fax:
Practice Address - Street 1:2010 INDUSTRIAL PARK RD.
Practice Address - Street 2:EL CENTRO FAMILY HEALTH
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3600
Practice Address - Country:US
Practice Address - Phone:505-753-7395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2012-0007363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61528021Medicaid
NMNMAAA2762Medicare PIN