Provider Demographics
NPI:1568982924
Name:OROZCO, ANGIE (ABOC)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:OROZCO
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16843 VALLEY BLVD STE E460
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6666
Mailing Address - Country:US
Mailing Address - Phone:909-952-9116
Mailing Address - Fax:909-600-7243
Practice Address - Street 1:16152 ORANGE CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-7739
Practice Address - Country:US
Practice Address - Phone:909-952-9116
Practice Address - Fax:909-600-7243
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070750156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty