MEDICARE: GLORIA C ANGELES CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	NA 3167	CA
2	367500000X	Certified Registered Nurse Anesthetist	RN480070	CA

General Provider Information

NPI Number	:	1184794042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA C ANGELES CRNA

Provider Business Mailing Address
First Line	:	5826 KELVIN AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-5313
Country	:	US
Telephone Number	:	818-932-0450
Fax Number	:	818-518-3537

Provider Business Practice Location Address
First Line	:	5826 KELVIN AVE
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-5313
Country	:	US
Telephone Number	:	818-932-0450
Fax Number	:	818-518-3537

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	11/28/2007

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