Provider Demographics
NPI:1336794940
Name:MOYA, ANGELICA (LVN)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:MOYA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 RICHMOND RD APT 2208
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0495
Mailing Address - Country:US
Mailing Address - Phone:903-293-4794
Mailing Address - Fax:
Practice Address - Street 1:5911 RICHMOND RD APT 2208
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0495
Practice Address - Country:US
Practice Address - Phone:903-293-4794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223885164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse