Provider Demographics
NPI:1750629564
Name:ANGEL OF FAITH NON PROFIT ORGANIZATION
Entity Type:Organization
Organization Name:ANGEL OF FAITH NON PROFIT ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-500-2774
Mailing Address - Street 1:4996 LA SIERRA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-2612
Mailing Address - Country:US
Mailing Address - Phone:951-500-2774
Mailing Address - Fax:951-358-0762
Practice Address - Street 1:21535 PALOMAR ST
Practice Address - Street 2:SUITE B
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7767
Practice Address - Country:US
Practice Address - Phone:951-500-2774
Practice Address - Fax:951-358-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)