Provider Demographics
NPI:1205590189
Name:OROSCO, MIRANDA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:OROSCO
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WILD HORSE LOOP
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1809
Mailing Address - Country:US
Mailing Address - Phone:949-355-1866
Mailing Address - Fax:
Practice Address - Street 1:1 TECHNOLOGY DR STE F211
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-5336
Practice Address - Country:US
Practice Address - Phone:949-835-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22801225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics