MEDICARE: ANGEL PEDIATRICS P.A.

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	208000000X	Pediatrics Physician	L8604	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	L8604	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1205071206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL PEDIATRICS P.A.

Provider Business Mailing Address
First Line	:	717 S GREENVILLE AVE
Second Line	:	SUITE 104
City	:	ALLEN
State	:	TX
Zip	:	75002-3317
Country	:	US
Telephone Number	:	972-396-1900
Fax Number	:	972-591-4589

Provider Business Practice Location Address
First Line	:	717 S GREENVILLE AVE
Second Line	:	SUITE 104
City	:	ALLEN
State	:	TX
Zip	:	75002-3317
Country	:	US
Telephone Number	:	972-396-1900
Fax Number	:	972-591-4589

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CHRISTINE LOYA
Credential	:
Telephone Number	:	214-616-6783

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	06/21/2018

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