Healthcare Provider Details

I. General information

NPI: 1366220196
Provider Name (Legal Business Name): FREDERICK ORANTES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6736 LAUREL CANYON BLVD
NORTH HOLLYWOOD CA
91606-1538
US

IV. Provider business mailing address

17934 VANOWEN ST
RESEDA CA
91335-5636
US

V. Phone/Fax

Practice location:
  • Phone: 818-755-8786
  • Fax:
Mailing address:
  • Phone: 818-277-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC18674
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: