Provider Demographics
NPI:1558987347
Name:ARREDONDO, ANGELICA BEATRIZ
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:BEATRIZ
Last Name:ARREDONDO
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 1:17317 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:ESPARTO
Mailing Address - State:CA
Mailing Address - Zip Code:95627-2137
Mailing Address - Country:US
Mailing Address - Phone:530-787-4110
Mailing Address - Fax:530-787-4110
Practice Address - Street 1:1540 SUTTER AVE
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-4341
Practice Address - Country:US
Practice Address - Phone:510-327-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2022-08-25
Deactivation Date:2022-07-27
Deactivation Code:
Reactivation Date:2022-08-25
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA1054001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program