Basic Information
Provider Information | |||||||||
NPI: | 1275896227 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CANGCO | ||||||||
FirstName: | ELLEN | ||||||||
MiddleName: | CALLUENG | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CANGCO | ||||||||
OtherFirstName: | ELLEN | ||||||||
OtherMiddleName: | CALLUENG | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | RN | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 8026 SEMINARIO | ||||||||
Address2: |   | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782505177 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2105229779 | ||||||||
FaxNumber: | 2105229779 | ||||||||
Practice Location | |||||||||
Address1: | 7400 MERTON MINTER ST | ||||||||
Address2: |   | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782294404 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2106175300 | ||||||||
FaxNumber: | 2109493884 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/23/2012 | ||||||||
LastUpdateDate: | 06/23/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 682787 | TX | Y |   | Nursing Service Providers | Registered Nurse |   |
No ID Information.