Provider Demographics
NPI:1457412710
Name:ANGEL'S STAR WELLNESS CENTER, P.A
Entity Type:Organization
Organization Name:ANGEL'S STAR WELLNESS CENTER, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-791-1811
Mailing Address - Street 1:8325 WHITLEY RD
Mailing Address - Street 2:SUITE: 100
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2487
Mailing Address - Country:US
Mailing Address - Phone:817-479-1181
Mailing Address - Fax:817-750-2789
Practice Address - Street 1:8325 WHITLEY RD
Practice Address - Street 2:SUITE: 100
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2487
Practice Address - Country:US
Practice Address - Phone:817-479-1181
Practice Address - Fax:817-918-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0072PDOtherBCBS
TX191341001Medicaid
DH2407OtherMEDICARE RAILROAD
DH2407OtherMEDICARE RAILROAD