Healthcare Provider Details

I. General information

NPI: 1578823217
Provider Name (Legal Business Name): JENNIFER MILLER OROSCO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2012
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 IRVINE AVE STE 152
COSTA MESA CA
92627-6649
US

IV. Provider business mailing address

393 N MAPLEWOOD ST
ORANGE CA
92866-1214
US

V. Phone/Fax

Practice location:
  • Phone: 949-781-3040
  • Fax:
Mailing address:
  • Phone: 949-933-9826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA129316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: