Healthcare Provider Details

I. General information

NPI: 1669623955
Provider Name (Legal Business Name): ANGEL M CARRANZA RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2008
Last Update Date: 10/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 SKY POINTE DR STE. 140-398
LAS VEGAS NV
89131-4047
US

IV. Provider business mailing address

5712 WHALE ROCK ST
LAS VEGAS NV
89149-4901
US

V. Phone/Fax

Practice location:
  • Phone: 702-501-0325
  • Fax:
Mailing address:
  • Phone: 702-219-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1526
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: