Healthcare Provider Details

I. General information

NPI: 1972428530
Provider Name (Legal Business Name): JESSICA MICHELLE BISSONTZ CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N TUSTIN AVE STE 310
SANTA ANA CA
92705-8699
US

IV. Provider business mailing address

1401 N TUSTIN AVE STE 310
SANTA ANA CA
92705-8699
US

V. Phone/Fax

Practice location:
  • Phone: 949-988-7928
  • Fax: 949-861-9539
Mailing address:
  • Phone: 949-988-7928
  • Fax: 949-861-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO04787
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO04787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: