Provider Demographics
NPI:1285251090
Name:ANGELES, MYLENE VALERA (APRN-FNPC)
Entity type:Individual
Prefix:
First Name:MYLENE
Middle Name:VALERA
Last Name:ANGELES
Suffix:
Gender:F
Credentials:APRN-FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19620 WYANDOTTE ST APT 11
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3494
Mailing Address - Country:US
Mailing Address - Phone:650-444-3056
Mailing Address - Fax:
Practice Address - Street 1:6330 W FLAMINGO RD UNIT 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2234
Practice Address - Country:US
Practice Address - Phone:702-444-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV812724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily