Provider Demographics
NPI:1609679695
Name:ANGELO, CODY
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:ANGELO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7061 W ARBY AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4464
Mailing Address - Country:US
Mailing Address - Phone:702-485-5515
Mailing Address - Fax:702-485-5515
Practice Address - Street 1:7061 W ARBY AVE STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4464
Practice Address - Country:US
Practice Address - Phone:702-485-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician