Healthcare Provider Details

I. General information

NPI: 1639881915
Provider Name (Legal Business Name): ANGEL NILO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 S VERMONT AVE # L102
TORRANCE CA
90502-1029
US

IV. Provider business mailing address

19401 S VERMONT AVE # L102
TORRANCE CA
90502-1029
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-6887
  • Fax:
Mailing address:
  • Phone: 310-323-6887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: