Provider Demographics
NPI:1609280098
Name:ANGULO, KEILA MAJALIA
Entity type:Individual
Prefix:MRS
First Name:KEILA
Middle Name:MAJALIA
Last Name:ANGULO
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:CARRETERA 188 INT 187
Mailing Address - Street 2:APARTADO 509
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772
Mailing Address - Country:US
Mailing Address - Phone:787-876-2042
Mailing Address - Fax:787-526-3749
Practice Address - Street 1:CARRETERA 188 INT 187
Practice Address - Street 2:APARTADO 509
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-876-2042
Practice Address - Fax:787-526-3749
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10610104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker