Healthcare Provider Details

I. General information

NPI: 1093413437
Provider Name (Legal Business Name): NANOR MARY KECHICHIAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W LA VETA AVE STE 260
ORANGE CA
92868-4439
US

IV. Provider business mailing address

725 W LA VETA AVE STE 260
ORANGE CA
92868-4439
US

V. Phone/Fax

Practice location:
  • Phone: 714-711-8006
  • Fax:
Mailing address:
  • Phone: 714-711-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: