Basic Information
Provider Information | |||||||||
NPI: | 1790103158 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OROZCO | ||||||||
FirstName: | ANGELA | ||||||||
MiddleName: | MONIQUE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MAYORGA | ||||||||
OtherFirstName: | ANGELA | ||||||||
OtherMiddleName: | MONIQUE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 9910 FRANKLIN SQUARE DR # 2110 | ||||||||
Address2: |   | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 212364902 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4109336421 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1032 S CESAR E CHAVEZ DR | ||||||||
Address2: |   | ||||||||
City: | MILWAUKEE | ||||||||
State: | WI | ||||||||
PostalCode: | 532042203 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4146721353 | ||||||||
FaxNumber: | 4146720191 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/02/2014 | ||||||||
LastUpdateDate: | 04/25/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/25/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 76847-20 | WI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208000000X | D85038 | MD | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 207R00000X | D85038 | MD | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | D85038 | 01 | MD | LICENSE | OTHER |