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NPI Code Detail

MEDICARE: MS. ANGELA MISURACO N.P.

MEDICARE: MS. ANGELA MISURACO N.P.
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
1363L00000XNurse Practitioner141587MO
2363L00000XNurse Practitioner95008948CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1827320581OTHERMOCPIN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114901279
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANGELA MISURACO N.P.
Provider Business Mailing Address
First Line : 2050 S BLOSSER RD
Second Line :
City : SANTA MARIA
State : CA
Zip : 93458-7310
Country : US
Telephone Number : 805-361-8028
Fax Number : 805-361-8097
Provider Business Practice Location Address
First Line : 2801 SANTA MARIA WAY
Second Line :
City : SANTA MARIA
State : CA
Zip : 93455-2118
Country : US
Telephone Number : 636-449-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2005
Last Update Date : 10/02/2018

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