Provider Demographics
NPI:1578637070
Name:OROZCO FONSECA, JORGE (DC)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:OROZCO FONSECA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 W SAN BERNARDINO RD
Mailing Address - Street 2:APT. 215
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-4102
Mailing Address - Country:US
Mailing Address - Phone:626-246-2204
Mailing Address - Fax:
Practice Address - Street 1:1116 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-2021
Practice Address - Country:US
Practice Address - Phone:626-917-6993
Practice Address - Fax:626-918-5432
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor