Provider Demographics
NPI:1962412106
Name:ANG-ERMOCILLA, BEATRIZ (MD)
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:ANG-ERMOCILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BEATRIZ
Other - Middle Name:L
Other - Last Name:ANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2870 S MARYLAND PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1548
Mailing Address - Country:US
Mailing Address - Phone:725-204-7848
Mailing Address - Fax:877-275-8844
Practice Address - Street 1:2870 S MARYLAND PKWY STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1548
Practice Address - Country:US
Practice Address - Phone:725-204-7848
Practice Address - Fax:877-275-8844
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVI24565Medicare UPIN
NV100183Medicare ID - Type Unspecified