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NPI Code Detail

MEDICARE: JOANNA ANGELOS

MEDICARE:   JOANNA  ANGELOS
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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1124383880
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNA ANGELOS
Provider Business Mailing Address
First Line : 3150 SOFT BREEZES DR APT 1010
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-7224
Country : US
Telephone Number : 224-766-0211
Fax Number :
Provider Business Practice Location Address
First Line : 3150 SOFT BREEZES DRIVE
Second Line : 1010
City : LAS VEGAS
State : NV
Zip : 89128
Country : US
Telephone Number : 224-766-0211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2012
Last Update Date : 08/06/2012

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Directions to “ JOANNA ANGELOS ” Practice Location

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