Healthcare Provider Details

I. General information

NPI: 1114237104
Provider Name (Legal Business Name): MARITZA HARRISON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 E 4TH ST STE 122
SANTA ANA CA
92705-3912
US

IV. Provider business mailing address

2021 E 4TH ST STE 122
SANTA ANA CA
92705-3912
US

V. Phone/Fax

Practice location:
  • Phone: 951-268-6995
  • Fax: 951-268-6559
Mailing address:
  • Phone: 951-268-6995
  • Fax: 951-268-6559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: