Healthcare Provider Details

I. General information

NPI: 1326712704
Provider Name (Legal Business Name): AGUSTIN OROZCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77682 COUNTRY CLUB DR STE G
PALM DESERT CA
92211-0453
US

IV. Provider business mailing address

2066 ZACHARY CT
PALM SPRINGS CA
92262-4040
US

V. Phone/Fax

Practice location:
  • Phone: 760-345-2200
  • Fax: 760-345-2210
Mailing address:
  • Phone: 760-898-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: