MEDICARE: CRIS ANGEL MS, DA, AEMP, HDD

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	171100000X	Acupuncturist	LAC0000511	WA
2	171100000X	Acupuncturist	AC00000511	WA

General Provider Information

NPI Number	:	1619971991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRIS ANGEL MS, DA, AEMP, HDD

Provider Business Mailing Address
First Line	:	914 164TH ST SE
Second Line	:	SUITE B12 - 202
City	:	MILL CREEK
State	:	WA
Zip	:	98012
Country	:	US
Telephone Number	:	206-454-8224
Fax Number	:	401-429-6150

Provider Business Practice Location Address
First Line	:	8229 44TH AVE W
Second Line	:	SUITE F
City	:	MUKILTEO
State	:	WA
Zip	:	98275
Country	:	US
Telephone Number	:	206-454-8224
Fax Number	:	401-429-6150

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	09/18/2019

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