Basic Information
Provider Information | |||||||||
NPI: | 1427442649 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OROZCO | ||||||||
FirstName: | ROSA | ||||||||
MiddleName: | MARIA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ORTEGA | ||||||||
OtherFirstName: | ROSA | ||||||||
OtherMiddleName: | MARIA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1501 HUGHES WAY | ||||||||
Address2: | SUITE 150 | ||||||||
City: | LONG BEACH | ||||||||
State: | CA | ||||||||
PostalCode: | 908101876 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3102216336 | ||||||||
FaxNumber: | 3102216350 | ||||||||
Practice Location | |||||||||
Address1: | 1501 HUGHES WAY | ||||||||
Address2: | SUITE 150 | ||||||||
City: | LONG BEACH | ||||||||
State: | CA | ||||||||
PostalCode: | 908101876 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3102216336 | ||||||||
FaxNumber: | 3102216350 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/25/2015 | ||||||||
LastUpdateDate: | 06/02/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/02/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF90909 | CA | N |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   | 106H00000X | LMFT128175 | CA | Y |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.