Healthcare Provider Details

I. General information

NPI: 1902023906
Provider Name (Legal Business Name): ANGELINA MARIA DE LA PAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELINA MARIA MORALES

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2549 W SHAW AVE
FRESNO CA
93711-3308
US

IV. Provider business mailing address

2550 W CLINTON AVE BLDG W
FRESNO CA
93705-4206
US

V. Phone/Fax

Practice location:
  • Phone: 559-321-6003
  • Fax:
Mailing address:
  • Phone: 559-264-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: