Organization
LITTLE ANGELS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA CRUZ RN (OWNER)
(208) 346-2222
Entity
Organization
Contact information
Practice address
1680 WOODRUFF PARK, IDAHO FALLS, ID 83401-3330
(208) 346-2222
Mailing address
1680 WOODRUFF PARK, IDAHO FALLS, ID 83401-3330
(208) 346-2222
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N38708
ID
2084P0800X
Psychiatry Physician
M9188
ID
2084P0804X
Child & Adolescent Psychiatry Physician
M9188
ID
363A00000X
Physician Assistant
Primary
PA334
ID
Other
Enumeration date
12/31/2012
Last updated
04/17/2013
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