Provider Demographics
NPI:1902023906
Name:DE LA PAZ, ANGELINA MARIA
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:MARIA
Last Name:DE LA PAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:MARIA
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 W CLINTON AVE BLDG W
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-4206
Mailing Address - Country:US
Mailing Address - Phone:559-264-7521
Mailing Address - Fax:
Practice Address - Street 1:2549 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3308
Practice Address - Country:US
Practice Address - Phone:559-321-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902023906OtherAOD COUNSELOR