Healthcare Provider Details

I. General information

NPI: 1174458236
Provider Name (Legal Business Name): ANGEL ROJAS RASO MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 WILSON ST
LAWTON OK
73503-4472
US

IV. Provider business mailing address

12 NW PLEASANT VIEW RDG
LAWTON OK
73505-9503
US

V. Phone/Fax

Practice location:
  • Phone: 916-459-0623
  • Fax:
Mailing address:
  • Phone: 916-459-0623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116710
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number116710
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116710
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: