Healthcare Provider Details

I. General information

NPI: 1184806382
Provider Name (Legal Business Name): LORETTA J. AMITRANO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 W UMPQUA ST SUITE 101
ROSEBURG OR
97471
US

IV. Provider business mailing address

12900 PARK PLAZA DR STE 150
CERRITOS CA
90703-9329
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-9596
  • Fax: 541-464-3519
Mailing address:
  • Phone: 562-977-4639
  • Fax: 526-741-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP2854
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111603
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200950086NP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF341031
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: