Healthcare Provider Details

I. General information

NPI: 1326470683
Provider Name (Legal Business Name): LEEZA CAMACHO WILLS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 08/03/2022
Certification Date: 06/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE STE 770
ORANGE CA
92868-4229
US

IV. Provider business mailing address

1140 W LA VETA AVE STE 770
ORANGE CA
92868-4229
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-8715
  • Fax:
Mailing address:
  • Phone: 714-835-8715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number462152
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP95008565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: