Provider Demographics
NPI:1073954707
Name:VELA-BROADDUS, ANGELA PRISCILLA (MSW)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:PRISCILLA
Last Name:VELA-BROADDUS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:PRISCILLA
Other - Last Name:VELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:3780 ROSIN CT STE 110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1698
Mailing Address - Country:US
Mailing Address - Phone:916-441-0226
Mailing Address - Fax:916-441-0286
Practice Address - Street 1:4433 FLORIN RD STE 600
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2527
Practice Address - Country:US
Practice Address - Phone:916-234-2577
Practice Address - Fax:916-236-2577
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1140291041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical