Healthcare Provider Details

I. General information

NPI: 1790804466
Provider Name (Legal Business Name): BEATRIZ SUSANA ORVIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 W TWISTED OAK DR
SIMI VALLEY CA
93065-8241
US

IV. Provider business mailing address

90 W TWISTED OAK DR
SIMI VALLEY CA
93065-8241
US

V. Phone/Fax

Practice location:
  • Phone: 818-207-6871
  • Fax: 818-337-2014
Mailing address:
  • Phone: 818-207-6871
  • Fax: 818-337-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number268100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: