Provider Demographics
NPI:1619660701
Name:ORILLOSA, CHARIE MAE GARCIA
Entity Type:Individual
Prefix:MISS
First Name:CHARIE MAE
Middle Name:GARCIA
Last Name:ORILLOSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6838 THISTLE ST
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9110
Mailing Address - Country:US
Mailing Address - Phone:951-520-5599
Mailing Address - Fax:
Practice Address - Street 1:1185 MAGNOLIA AVE STE C-D
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3218
Practice Address - Country:US
Practice Address - Phone:951-268-9184
Practice Address - Fax:951-268-9195
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10526237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty