Healthcare Provider Details

I. General information

NPI: 1396593265
Provider Name (Legal Business Name): ASHLEY MAE ORCUTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SPRUCE ST STE 250
RIVERSIDE CA
92507-7429
US

IV. Provider business mailing address

29551 TROON CT
MURRIETA CA
92563-6771
US

V. Phone/Fax

Practice location:
  • Phone: 951-297-8366
  • Fax:
Mailing address:
  • Phone: 951-297-8366
  • 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
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: