Provider Demographics
NPI:1669623955
Name:CARRANZA, ANGEL M (RPT)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:M
Last Name:CARRANZA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 WHALE ROCK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4901
Mailing Address - Country:US
Mailing Address - Phone:702-219-4299
Mailing Address - Fax:
Practice Address - Street 1:6440 SKY POINTE DR
Practice Address - Street 2:STE. 140-398
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4047
Practice Address - Country:US
Practice Address - Phone:702-501-0325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-04
Last Update Date:2008-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15262251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics