Provider Demographics
NPI:1023250784
Name:VIZCARRA, MICHAEL JORDAN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JORDAN
Last Name:VIZCARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11180 WARNER AVE
Mailing Address - Street 2:SUITE 455
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7501
Mailing Address - Country:US
Mailing Address - Phone:714-556-0536
Mailing Address - Fax:714-435-9640
Practice Address - Street 1:11180 WARNER AVE
Practice Address - Street 2:SUITE 455
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7501
Practice Address - Country:US
Practice Address - Phone:714-556-0536
Practice Address - Fax:714-435-9640
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124349207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology