Healthcare Provider Details

I. General information

NPI: 1689126880
Provider Name (Legal Business Name): ANGELINA FRIAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5083 AVENIDA DEL SOL
LAS CRUCES NM
88011
US

IV. Provider business mailing address

5083 AVENIDA DEL SOL
LAS CRUCES NM
88011
US

V. Phone/Fax

Practice location:
  • Phone: 575-202-0298
  • Fax:
Mailing address:
  • Phone: 575-202-0298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberX-09611
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: