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General NPI Number Information
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NPI Number | 1801237136
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Entity Type | Individual
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Provider Name | LORI GORDON RN
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Gender | Female
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 1030 W WARNER AVE
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City | SANTA ANA
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State | CA
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Zip | 92707-3147
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Country | US
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Telephone | 714-834-6915
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Fax |
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Provider Business Mailing Address
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Address Line | 9311 WINTERWOOD CIR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-5940
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Country | US
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Telephone | 714-393-7691
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 499587
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License Number State | CA
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