Provider Demographics
NPI:1285818559
Name:ORTIZ-FLORES, ANGELA CARMEL (LISW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CARMEL
Last Name:ORTIZ-FLORES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 CAMINO IRIS
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4953
Mailing Address - Country:US
Mailing Address - Phone:505-699-0592
Mailing Address - Fax:
Practice Address - Street 1:2019 GALISTEO ST
Practice Address - Street 2:STE M5
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2106
Practice Address - Country:US
Practice Address - Phone:505-982-0191
Practice Address - Fax:505-983-6402
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-062551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78558Medicaid