Provider Demographics
NPI:1285461392
Name:ANDERSON, ANGELICA MARIA (CHW, CPW, CCMA)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CHW, CPW, CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 WACO ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-2452
Mailing Address - Country:US
Mailing Address - Phone:813-727-0918
Mailing Address - Fax:
Practice Address - Street 1:2201 WACO ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-2452
Practice Address - Country:US
Practice Address - Phone:813-727-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13247172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker