Provider Demographics
NPI:1437830833
Name:ANGULO, DEZARAE SALIN
Entity Type:Individual
Prefix:
First Name:DEZARAE
Middle Name:SALIN
Last Name:ANGULO
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 1:2197 S 4TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6473
Mailing Address - Country:US
Mailing Address - Phone:928-920-6220
Mailing Address - Fax:928-259-7272
Practice Address - Street 1:2197 S 4TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6473
Practice Address - Country:US
Practice Address - Phone:928-920-6220
Practice Address - Fax:928-259-7272
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty