Provider Demographics
NPI:1285087551
Name:DELOSANGELES, JUDITH
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:DELOSANGELES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 SKY COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-6803
Mailing Address - Country:US
Mailing Address - Phone:775-690-3545
Mailing Address - Fax:
Practice Address - Street 1:3160 SKY COUNTRY DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-6803
Practice Address - Country:US
Practice Address - Phone:775-690-3545
Practice Address - Fax:775-327-4580
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005047947Medicaid