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General NPI Number Information
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NPI Number | 1376589580
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Entity Type | Organization
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Legal Business Name | ANGEL DE LA GUARDIA
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1721 E GRIFFIN PKWY SUITE A
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City | MISSION
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State | TX
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Zip | 78572-3103
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Country | US
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Telephone | 956-584-3196
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Fax | 956-584-3187
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Provider Business Mailing Address
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Address Line | 1721 E GRIFFIN PKWY SUITE A
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City | MISSION
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State | TX
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Zip | 78572-3103
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Country | US
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Telephone | 956-584-3196
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Fax | 956-584-3187
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ROBERTO HERNANDEZ
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Credential | COTA/L
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Telephone | 956-584-3196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | PENDING
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License Number State | TX
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