Provider Demographics
NPI:1063296002
Name:TODOROVICH, AUTUMN NOELLE
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:NOELLE
Last Name:TODOROVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:NOELLE
Other - Last Name:BENNINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6328 MOUNT RIPLEY DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4029
Mailing Address - Country:US
Mailing Address - Phone:714-851-0129
Mailing Address - Fax:
Practice Address - Street 1:6328 MOUNT RIPLEY DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4029
Practice Address - Country:US
Practice Address - Phone:714-851-0129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95170136163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency