Provider Demographics
NPI:1932599024
Name:MCCRILLIS, ANGELA (CSFA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MCCRILLIS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14400 HIGHWAY 59 N APT 907
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-3436
Mailing Address - Country:US
Mailing Address - Phone:281-324-5660
Mailing Address - Fax:
Practice Address - Street 1:14400 HIGHWAY 59 N APT 907
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-3436
Practice Address - Country:US
Practice Address - Phone:281-324-5660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
147037246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant