Healthcare Provider Details

I. General information

NPI: 1194551408
Provider Name (Legal Business Name): MONIQUE DIOSA ORITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9718 HARVARD ST
BELLFLOWER CA
90706-3635
US

IV. Provider business mailing address

9718 HARVARD ST
BELLFLOWER CA
90706-3635
US

V. Phone/Fax

Practice location:
  • Phone: 562-925-2777
  • Fax: 562-925-7572
Mailing address:
  • Phone: 562-539-6281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1572420824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: