Provider Demographics
NPI:1417443292
Name:SAENZ, ANGELA REYES (CI12000218)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:REYES
Last Name:SAENZ
Suffix:
Gender:F
Credentials:CI12000218
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1081 CAMINO DEL RIO S STE 129
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3544
Mailing Address - Country:US
Mailing Address - Phone:619-239-9691
Mailing Address - Fax:619-239-0909
Practice Address - Street 1:726 F ST FL 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6303
Practice Address - Country:US
Practice Address - Phone:619-239-9691
Practice Address - Fax:619-239-0909
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI12000218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)