Provider Demographics
NPI:1417716168
Name:AGORRILLA, MITCH ARNOLD (RN)
Entity Type:Individual
Prefix:
First Name:MITCH
Middle Name:ARNOLD
Last Name:AGORRILLA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40363 WENHAM WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4405
Mailing Address - Country:US
Mailing Address - Phone:661-435-5470
Mailing Address - Fax:
Practice Address - Street 1:1600 CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7626
Practice Address - Country:US
Practice Address - Phone:626-943-6088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV870913163W00000X
CA95080417163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse