Provider Demographics
NPI:1144868050
Name:MA, JANET ((MSN, FNP))
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:(MSN, FNP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W LA VETA AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4447
Mailing Address - Country:US
Mailing Address - Phone:714-628-9342
Mailing Address - Fax:
Practice Address - Street 1:1422 EDINGER AVE STE 130
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6298
Practice Address - Country:US
Practice Address - Phone:714-628-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily