Provider Demographics
NPI:1184917015
Name:ORNELAS, SUSANA (MSW)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:ORNELAS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29700 SAN FRANCISQUITO CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-4926
Mailing Address - Country:US
Mailing Address - Phone:661-296-6305
Mailing Address - Fax:
Practice Address - Street 1:29700 SAN FRANCISQUITO CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-4926
Practice Address - Country:US
Practice Address - Phone:661-296-6305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program