Provider Demographics
NPI:1548514813
Name:OROZCO, MARISOL (PHYSICIAN ASISTANT)
Entity type:Individual
Prefix:MS
First Name:MARISOL
Middle Name:
Last Name:OROZCO
Suffix:
Gender:F
Credentials:PHYSICIAN ASISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7104 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1106
Mailing Address - Country:US
Mailing Address - Phone:718-238-2100
Mailing Address - Fax:718-748-0863
Practice Address - Street 1:7104 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1106
Practice Address - Country:US
Practice Address - Phone:718-238-2100
Practice Address - Fax:718-748-0863
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009051-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical