Healthcare Provider Details

I. General information

NPI: 1720507437
Provider Name (Legal Business Name): SUSANA ORTEGA RIOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOPE DR
TUSTIN CA
92782-0221
US

IV. Provider business mailing address

1 HOPE DR
TUSTIN CA
92782-0221
US

V. Phone/Fax

Practice location:
  • Phone: 714-247-0300
  • Fax: 714-259-1598
Mailing address:
  • Phone: 714-247-0300
  • Fax: 714-259-1598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: