MEDICARE: ANGEL FASCIO

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	174400000X	Specialist	L1000740518	LA

General Provider Information

NPI Number	:	1134964984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL FASCIO

Provider Business Mailing Address
First Line	:	11020 GUILDFORD RD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2337
Country	:	US
Telephone Number	:	504-427-0217
Fax Number	:

Provider Business Practice Location Address
First Line	:	11020 GUILDFORD RD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2337
Country	:	US
Telephone Number	:	504-427-0217
Fax Number	:

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

Provider Enumeration Date	:	06/25/2024
Last Update Date	:	06/25/2024

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Directions to “ ANGEL FASCIO ” Practice Location

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