Provider Demographics
NPI:1447672696
Name:ORIGEL, LUIS JR
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:ORIGEL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19809 LANFRANCA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3898
Mailing Address - Country:US
Mailing Address - Phone:661-289-1154
Mailing Address - Fax:818-450-0133
Practice Address - Street 1:10200 SEPULVEDA BLVD STE 140
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-3323
Practice Address - Country:US
Practice Address - Phone:661-289-1154
Practice Address - Fax:818-450-0133
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily