Basic Information
Provider Information
NPI: 1306573811
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ORPILLA
FirstName: JOHN GABRIEL
MiddleName: RICAHUERTA
NamePrefix: MR.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11040 WILSON CV
Address2:  
City: LOMA LINDA
State: CA
PostalCode: 923546512
CountryCode: US
TelephoneNumber: 9099532005
FaxNumber:  
Practice Location
Address1: 400 N PEPPER AVE
Address2:  
City: COLTON
State: CA
PostalCode: 923241819
CountryCode: US
TelephoneNumber: 9095801000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/04/2022
LastUpdateDate: 08/04/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/04/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X849561CAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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