Provider Demographics
NPI:1447609581
Name:FLORES, ANJELICA DONATA (ASW, PPSC)
Entity Type:Individual
Prefix:
First Name:ANJELICA
Middle Name:DONATA
Last Name:FLORES
Suffix:
Gender:F
Credentials:ASW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S BELLA VISTA ST APT 18
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1535
Mailing Address - Country:US
Mailing Address - Phone:909-609-5135
Mailing Address - Fax:
Practice Address - Street 1:7855 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3150
Practice Address - Country:US
Practice Address - Phone:714-507-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW655371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical