=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962910828
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAYELA DELGADO ANGELES PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2018
-----------------------------------------------------
Last Update Date | 04/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 170 MUNICIPAL DR
-----------------------------------------------------
City | GUN BARREL CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75156-3704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-887-7992
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 MEDICAL CIR
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75751-9003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-676-3200
-----------------------------------------------------
Fax | 903-676-3277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA11624
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA11624
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------