Healthcare Provider Details

I. General information

NPI: 1609811868
Provider Name (Legal Business Name): MANUEL A ORELLANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 N CALIFORNIA ST #F
STOCKTON CA
95204
US

IV. Provider business mailing address

PO BOX 4488
STOCKTON CA
95204
US

V. Phone/Fax

Practice location:
  • Phone: 209-941-8073
  • Fax: 209-941-0230
Mailing address:
  • Phone: 209-941-8073
  • Fax: 209-941-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA500440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: