1902294150 NPI number — ANGEL UNAWARE

Table of content: GABRIELLA LEITE CRANE MD (NPI 1598931032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902294150 NPI number — ANGEL UNAWARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGEL UNAWARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902294150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6417 DRURY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76116-4403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-505-3867
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6417 DRURY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76116-4403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-505-3867
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOEHLER
Authorized Official First Name:
CONSTANCE
Authorized Official Middle Name:
DIANNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-505-3867

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)