Healthcare Provider Details

I. General information

NPI: 1073543054
Provider Name (Legal Business Name): MARIA VICTORIA ANGELES P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E EUREKA ST SUITE B
WEATHERFORD TX
76086
US

IV. Provider business mailing address

907 E EUREKA ST SUITE B
WEATHERFORD TX
76086
US

V. Phone/Fax

Practice location:
  • Phone: 817-599-4901
  • Fax: 817-599-4902
Mailing address:
  • Phone: 817-599-4901
  • Fax: 817-599-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA04455
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: