Healthcare Provider Details

I. General information

NPI: 1801237136
Provider Name (Legal Business Name): LORI GORDON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 W WARNER AVE
SANTA ANA CA
92707-3147
US

IV. Provider business mailing address

9311 WINTERWOOD CIR
HUNTINGTON BEACH CA
92646-5940
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-6915
  • Fax:
Mailing address:
  • Phone: 714-393-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number499587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: