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General NPI Number Information
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NPI Number | 1437495041
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Entity Type | Organization
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Legal Business Name | LITTLE ANGELS LLC
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 1680 WOODRUFF PARK
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3330
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Country | US
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Telephone | 208-346-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 1680 WOODRUFF PARK
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3330
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Country | US
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Telephone | 208-346-2222
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LISA CRUZ
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Credential | RN
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Telephone | 208-346-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | M9188
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | M9188
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | N38708
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA334
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License Number State | ID
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