Healthcare Provider Details

I. General information

NPI: 1568039444
Provider Name (Legal Business Name): MICHELLE DAEL ORTIZ BARRANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 07/21/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W TOWN AND COUNTRY RD STE 1250
ORANGE CA
92868-4633
US

IV. Provider business mailing address

1820 W ORANGEWOOD AVE STE 110
ORANGE CA
92868-5056
US

V. Phone/Fax

Practice location:
  • Phone: 949-357-2556
  • Fax: 855-568-2494
Mailing address:
  • Phone: 714-696-2862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: