Provider Demographics
NPI:1104100999
Name:ANGULO-PEREZ, MONICA D
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:D
Last Name:ANGULO-PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:ANGULO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24 WATSON PL
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1115
Mailing Address - Country:US
Mailing Address - Phone:845-249-8788
Mailing Address - Fax:
Practice Address - Street 1:24 WATSON PL
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1115
Practice Address - Country:US
Practice Address - Phone:845-249-8788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015760171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor