Provider Demographics
NPI:1326712704
Name:OROZCO, AGUSTIN
Entity Type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:
Last Name:OROZCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 ZACHARY CT
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4040
Mailing Address - Country:US
Mailing Address - Phone:760-898-2415
Mailing Address - Fax:
Practice Address - Street 1:77682 COUNTRY CLUB DR STE G
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0453
Practice Address - Country:US
Practice Address - Phone:760-345-2200
Practice Address - Fax:760-345-2210
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA19266171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician