Provider Demographics
NPI:1700750064
Name:RANGEL, CAROL ANN (IIS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:RANGEL
Suffix:
Gender:F
Credentials:IIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 COLLEGE AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4046
Mailing Address - Country:US
Mailing Address - Phone:209-238-9999
Mailing Address - Fax:
Practice Address - Street 1:1429 COLLEGE AVE STE A2
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4046
Practice Address - Country:US
Practice Address - Phone:209-238-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0128113802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty