Provider Demographics
NPI:1629513510
Name:BOLANOS- CASCIO, ANGIE (PPS)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:BOLANOS- CASCIO
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:BOLANOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1111 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-2002
Mailing Address - Country:US
Mailing Address - Phone:559-265-3000
Mailing Address - Fax:
Practice Address - Street 1:2091 BUSINESS CENTER DR
Practice Address - Street 2:150
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1130
Practice Address - Country:US
Practice Address - Phone:949-250-1101
Practice Address - Fax:949-250-1103
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-24325103K00000X
103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst