Provider Demographics
NPI:1861470890
Name:TAN-TORRES, ANGELITA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELITA
Middle Name:
Last Name:TAN-TORRES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:3201 S MARYLAND PKWY
Practice Address - Street 2:#400
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2441
Practice Address - Country:US
Practice Address - Phone:702-262-1130
Practice Address - Fax:702-262-1161
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA787363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC5864OtherBLUE
NV100500289Medicaid
NV100500289Medicaid
NV38063Medicare PIN
NVDB5826Medicare PIN