Provider Demographics
NPI:1255105714
Name:GUARDIAN ANGELS CLINIC PLLC
Entity type:Organization
Organization Name:GUARDIAN ANGELS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGINA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:972-352-8346
Mailing Address - Street 1:2105 CANTURA DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4652
Mailing Address - Country:US
Mailing Address - Phone:972-352-8346
Mailing Address - Fax:
Practice Address - Street 1:2105 CANTURA DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4652
Practice Address - Country:US
Practice Address - Phone:972-352-8346
Practice Address - Fax:972-352-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty