Healthcare Provider Details

I. General information

NPI: 1639182702
Provider Name (Legal Business Name): JANJA VILTUZNIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 E CHAPMAN AVE STE 205
ORANGE CA
92869-3226
US

IV. Provider business mailing address

2617 E CHAPMAN AVE STE 205
ORANGE CA
92869-3248
US

V. Phone/Fax

Practice location:
  • Phone: 714-538-6822
  • Fax: 714-280-4826
Mailing address:
  • Phone: 714-538-6822
  • Fax: 714-280-4826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA42658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: