Provider Demographics
NPI:1316627755
Name:GONZALES-ORR, ANGELINA
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:GONZALES-ORR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 FOREST GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-4824
Mailing Address - Country:US
Mailing Address - Phone:541-905-1438
Mailing Address - Fax:
Practice Address - Street 1:940 TOWN CENTRE DR STE B
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6165
Practice Address - Country:US
Practice Address - Phone:541-905-1438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27776225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist