Healthcare Provider Details

I. General information

NPI: 1033044466
Provider Name (Legal Business Name): JILL ANGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NEEL AVE
SOCORRO NM
87801-4649
US

IV. Provider business mailing address

817 DESI LOOP
BELEN NM
87002-8068
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-4357
  • Fax: 505-514-0732
Mailing address:
  • Phone: 505-430-0777
  • Fax: 505-514-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: