Provider Demographics
NPI:1841575669
Name:ANGAT, NELSON
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:ANGAT
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 1:2344 GRANNIS LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-5086
Mailing Address - Country:US
Mailing Address - Phone:702-431-3980
Mailing Address - Fax:
Practice Address - Street 1:2344 GRANNIS LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5086
Practice Address - Country:US
Practice Address - Phone:702-431-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor