Healthcare Provider Details

I. General information

NPI: 1922823079
Provider Name (Legal Business Name): ANGELICA CARDOZA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5212 SINCLAIR AVE
MIDLAND TX
79707-6301
US

IV. Provider business mailing address

702 W 21ST ST
ODESSA TX
79763-2833
US

V. Phone/Fax

Practice location:
  • Phone: 432-689-9898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2123409
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: