Provider Demographics
NPI:1669150652
Name:USCANGA, IVAN SOREL (RN)
Entity type:Individual
Prefix:MR
First Name:IVAN
Middle Name:SOREL
Last Name:USCANGA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:36065 SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT CAVAZOS
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5060
Mailing Address - Country:US
Mailing Address - Phone:254-287-1140
Mailing Address - Fax:254-285-5103
Practice Address - Street 1:36048 58TH STREET
Practice Address - Street 2:
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX812670163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management