Healthcare Provider Details

I. General information

NPI: 1205590189
Provider Name (Legal Business Name): MIRANDA OROSCO MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TECHNOLOGY DR STE F211
IRVINE CA
92618-5336
US

IV. Provider business mailing address

37 WILD HORSE LOOP
RANCHO SANTA MARGARITA CA
92688-1809
US

V. Phone/Fax

Practice location:
  • Phone: 949-835-3746
  • Fax:
Mailing address:
  • Phone: 949-355-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number22801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: