MEDICARE: MRS. SANDRA AVIGAIL ANGULO PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	72404	NM

General Provider Information

NPI Number	:	1033810676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA AVIGAIL ANGULO PMHNP-BC

Provider Business Mailing Address
First Line	:	9800 BERMUDA AVE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-5333
Country	:	US
Telephone Number	:	915-407-3117
Fax Number	:

Provider Business Practice Location Address
First Line	:	3751 DEL REY BLVD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-8526
Country	:	US
Telephone Number	:	575-382-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	03/10/2023

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