Healthcare Provider Details

I. General information

NPI: 1285843631
Provider Name (Legal Business Name): LORETTA MAZORRA N.P. AND C.N.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 CENTURY PARK LN SUITE 217
LOS ANGELES CA
90067-3300
US

IV. Provider business mailing address

2112 CENTURY PARK LN SUITE 217
LOS ANGELES CA
90067-3300
US

V. Phone/Fax

Practice location:
  • Phone: 310-772-0064
  • Fax: 310-772-0064
Mailing address:
  • Phone: 310-772-0064
  • Fax: 310-772-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1143834
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number1143834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: