MEDICARE: GRACE NOEMI ANGELES

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	101YP2500X	Professional Counselor	CTB-2024-0439	NM

General Provider Information

NPI Number	:	1477278216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE NOEMI ANGELES

Provider Business Mailing Address
First Line	:	861 VIA GLORIETA
Second Line	:
City	:	SUNLAND PARK
State	:	NM
Zip	:	88063-9629
Country	:	US
Telephone Number	:	915-549-2097
Fax Number	:	915-549-2097

Provider Business Practice Location Address
First Line	:	861 VIA GLORIETA
Second Line	:
City	:	SUNLAND PARK
State	:	NM
Zip	:	88063-9629
Country	:	US
Telephone Number	:	915-549-2097
Fax Number	:	915-549-2097

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

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	06/22/2024

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Directions to “ GRACE NOEMI ANGELES ” Practice Location

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