Healthcare Provider Details

I. General information

NPI: 1285818559
Provider Name (Legal Business Name): ANGELA CARMEL ORTIZ-FLORES LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST STE M5
SANTA FE NM
87505-2106
US

IV. Provider business mailing address

2255 CAMINO IRIS
SANTA FE NM
87505-4953
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-0191
  • Fax: 505-983-6402
Mailing address:
  • Phone: 505-699-0592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06255
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: