Provider Demographics
NPI:1114316528
Name:TERRAZAS, ANGELICA
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:TERRAZAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:TERRAZAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:31764 CASINO DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-4571
Mailing Address - Country:US
Mailing Address - Phone:951-471-4645
Mailing Address - Fax:951-471-4687
Practice Address - Street 1:31764 CASINO DR STE 300
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4571
Practice Address - Country:US
Practice Address - Phone:951-471-4645
Practice Address - Fax:951-471-4687
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-TOJXFZ175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist