Provider Demographics
NPI:1184992240
Name:MONDRAGON, ANGELITA JOSEPHINE (CAC III)
Entity type:Individual
Prefix:MS
First Name:ANGELITA
Middle Name:JOSEPHINE
Last Name:MONDRAGON
Suffix:
Gender:F
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 TEJON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-2214
Mailing Address - Country:US
Mailing Address - Phone:303-953-5913
Mailing Address - Fax:303-455-1332
Practice Address - Street 1:4055 TEJON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-2214
Practice Address - Country:US
Practice Address - Phone:303-953-5913
Practice Address - Fax:303-455-1332
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO245101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)