Healthcare Provider Details

I. General information

NPI: 1578996559
Provider Name (Legal Business Name): ANGELITA SOPHIA FLORES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 E FREEDOM RD
FRENCH CAMP CA
95231-9694
US

IV. Provider business mailing address

7777 E FREEDOM RD
FRENCH CAMP CA
95231-9694
US

V. Phone/Fax

Practice location:
  • Phone: 209-946-3400
  • Fax:
Mailing address:
  • Phone: 209-946-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW87568
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberASW29812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: