Provider Demographics
NPI:1902426398
Name:ATIENZA, ODRALEVA CASUGA (RN)
Entity Type:Individual
Prefix:
First Name:ODRALEVA
Middle Name:CASUGA
Last Name:ATIENZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ODRALEVA
Other - Middle Name:LOMBOY
Other - Last Name:CASUGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13406 HERITAGE WAY APT 430
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-9135
Mailing Address - Country:US
Mailing Address - Phone:949-933-6419
Mailing Address - Fax:
Practice Address - Street 1:550 N FLOWER ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2361
Practice Address - Country:US
Practice Address - Phone:949-933-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA764340163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse