Healthcare Provider Details

I. General information

NPI: 1750772000
Provider Name (Legal Business Name): MIKI K. TORTORELLI N.P.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16055 BROOKHURST ST STE C
FOUNTAIN VALLEY CA
92708-1566
US

IV. Provider business mailing address

16055 BROOKHURST ST STE C
FOUNTAIN VALLEY CA
92708-1566
US

V. Phone/Fax

Practice location:
  • Phone: 714-839-2400
  • Fax:
Mailing address:
  • Phone: 714-839-2400
  • Fax: 714-839-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number745193
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF95001943
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95001943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: