Healthcare Provider Details

I. General information

NPI: 1669007027
Provider Name (Legal Business Name): MARISOL ANGARITA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27420 JEFFERSON AVE STE 101B
TEMECULA CA
92590-2668
US

IV. Provider business mailing address

4910 THISTLE CREEK WAY
HEMET CA
92545-7057
US

V. Phone/Fax

Practice location:
  • Phone: 951-208-7584
  • Fax:
Mailing address:
  • Phone: 626-905-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number395294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: