Provider Demographics
NPI:1750313227
Name:ORBETON, ELLEN GRATA (CALIFORNIA LM)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:GRATA
Last Name:ORBETON
Suffix:
Gender:F
Credentials:CALIFORNIA LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 64
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:96117
Mailing Address - Country:US
Mailing Address - Phone:530-254-6908
Mailing Address - Fax:530-872-5645
Practice Address - Street 1:473-625 STURGILL ST.
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:CA
Practice Address - Zip Code:96117
Practice Address - Country:US
Practice Address - Phone:530-254-6908
Practice Address - Fax:530-872-5645
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN378428363LX0001X
CANMW751367A00000X
CALM415176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGNMW00010Medicaid