Healthcare Provider Details

I. General information

NPI: 1215792866
Provider Name (Legal Business Name): JAMES HENRIQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 S ANITA DR STE 201
ORANGE CA
92868-3346
US

IV. Provider business mailing address

265 S ANITA DR STE 201
ORANGE CA
92868-3346
US

V. Phone/Fax

Practice location:
  • Phone: 714-410-3505
  • Fax:
Mailing address:
  • Phone: 714-410-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: