Healthcare Provider Details

I. General information

NPI: 1548067184
Provider Name (Legal Business Name): CATHERINE GRACE HEYROSA RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE FAUSTINO HEYROSA RN

II. Dates (important events)

Enumeration Date: 03/01/2025
Last Update Date: 03/01/2025
Certification Date: 03/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3298
US

IV. Provider business mailing address

10839 SONOMA LN
GARDEN GROVE CA
92843-1226
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8781
  • Fax:
Mailing address:
  • Phone: 772-240-2071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number95328291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: