Provider Demographics
NPI:1205071206
Name:ANGEL PEDIATRICS P.A.
Entity type:Organization
Organization Name:ANGEL PEDIATRICS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-616-6783
Mailing Address - Street 1:717 S GREENVILLE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3317
Mailing Address - Country:US
Mailing Address - Phone:972-396-1900
Mailing Address - Fax:972-591-4589
Practice Address - Street 1:717 S GREENVILLE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3317
Practice Address - Country:US
Practice Address - Phone:972-396-1900
Practice Address - Fax:972-591-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8604208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200598502OtherMEDICAID TPI- GROUP HEALTH STEPS
TX200598501OtherMEDICAID TPI - GROUP
TX200601701OtherMEDICAID TX INDIVIDUAL TPI
TXL8604OtherLICENSE
TX=========OtherTAX ID