Healthcare Provider Details

I. General information

NPI: 1245816891
Provider Name (Legal Business Name): TODD IGNAT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 GARDEN GROVE BLVD STE 408
GARDEN GROVE CA
92843-1904
US

IV. Provider business mailing address

12555 GARDEN GROVE BLVD STE 408
GARDEN GROVE CA
92843-1904
US

V. Phone/Fax

Practice location:
  • Phone: 714-948-5003
  • Fax:
Mailing address:
  • Phone: 714-948-5003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95020482
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: