Healthcare Provider Details

I. General information

NPI: 1154122075
Provider Name (Legal Business Name): NICOLE CHIZARA OPARAUGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S STE 400
ORANGE CA
92868-3201
US

IV. Provider business mailing address

3343 BAGLEY AVE APT 1
LOS ANGELES CA
90034-2836
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5691
  • Fax:
Mailing address:
  • Phone: 760-985-4170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: