Provider Demographics
NPI:1376392076
Name:PASCUAL MEDINA, ANGIE PASCUAL NAZARETH
Entity type:Individual
Prefix:
First Name:ANGIE PASCUAL
Middle Name:NAZARETH
Last Name:PASCUAL MEDINA
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 1:101 W CENTRAL TEXAS EXPY STE 101
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1704
Mailing Address - Country:US
Mailing Address - Phone:786-372-2481
Mailing Address - Fax:
Practice Address - Street 1:101 W CENTRAL TEXAS EXPY STE 101
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1704
Practice Address - Country:US
Practice Address - Phone:205-862-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician