Provider Demographics
NPI:1114281003
Name:ENRIQUEZ, ANGELICA GUADALUPE
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:GUADALUPE
Last Name:ENRIQUEZ
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 1:1908 N. WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458
Mailing Address - Country:US
Mailing Address - Phone:805-868-0734
Mailing Address - Fax:
Practice Address - Street 1:1908 N. WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458
Practice Address - Country:US
Practice Address - Phone:805-868-0734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health