MEDICARE: MYLENE VALERA ANGELES APRN-FNPC

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	363LF0000X	Family Nurse Practitioner	812724	NV

General Provider Information

NPI Number	:	1285251090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYLENE VALERA ANGELES APRN-FNPC

Provider Business Mailing Address
First Line	:	19620 WYANDOTTE ST APT 11
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-3494
Country	:	US
Telephone Number	:	650-444-3056
Fax Number	:

Provider Business Practice Location Address
First Line	:	6330 W FLAMINGO RD UNIT 102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-2234
Country	:	US
Telephone Number	:	702-444-7744
Fax Number	:

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

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	01/20/2022

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Directions to “ MYLENE VALERA ANGELES APRN-FNPC” Practice Location

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