Healthcare Provider Details

I. General information

NPI: 1528991742
Provider Name (Legal Business Name): MRS. AMY RANGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 ENDLESS VIS
ALISO VIEJO CA
92656-8057
US

IV. Provider business mailing address

83 ENDLESS VIS
ALISO VIEJO CA
92656-8057
US

V. Phone/Fax

Practice location:
  • Phone: 949-705-8775
  • Fax:
Mailing address:
  • Phone: 949-705-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number14219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: