Healthcare Provider Details

I. General information

NPI: 1891602538
Provider Name (Legal Business Name): ANGEL ORDAZ MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9340 E STOCKTON BLVD
ELK GROVE CA
95624-1563
US

IV. Provider business mailing address

206 CINDY LN
GALT CA
95632-2113
US

V. Phone/Fax

Practice location:
  • Phone: 916-509-8198
  • Fax:
Mailing address:
  • Phone: 209-263-8892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW139030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: