Provider Demographics
NPI:1114553419
Name:OROZCO, IRENE (NP)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:OROZCO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 WILSHIRE BLVD STE 1180
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2361
Mailing Address - Country:US
Mailing Address - Phone:323-419-1074
Mailing Address - Fax:
Practice Address - Street 1:2920 TELEGRAPH AVE STE 100
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2031
Practice Address - Country:US
Practice Address - Phone:510-686-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010181363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty