Provider Demographics
NPI:1982452777
Name:ANGELS CCS LLC
Entity Type:Organization
Organization Name:ANGELS CCS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-451-1357
Mailing Address - Street 1:1300 PASEO LA PALMA, PH 3A APT 27
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714
Mailing Address - Country:US
Mailing Address - Phone:956-451-1357
Mailing Address - Fax:
Practice Address - Street 1:1300 PASEO LA PALMA, PH 3A APT 27
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714
Practice Address - Country:US
Practice Address - Phone:956-451-1357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty