Healthcare Provider Details

I. General information

NPI: 1790103158
Provider Name (Legal Business Name): ANGELA MONIQUE OROZCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA MONIQUE MAYORGA

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 S CESAR E CHAVEZ DR
MILWAUKEE WI
53204-2203
US

IV. Provider business mailing address

PO BOX 778789
CHICAGO IL
60677-8789
US

V. Phone/Fax

Practice location:
  • Phone: 414-672-1353
  • Fax: 414-672-0191
Mailing address:
  • Phone: 414-672-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD85038
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number76847-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD85038
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: