Healthcare Provider Details

I. General information

NPI: 1235045642
Provider Name (Legal Business Name): PATRICIA ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6098 REYES ADOBE RD
AGOURA HILLS CA
91301-2105
US

IV. Provider business mailing address

3051 VILLAGE AT THE PARK DR APT 219
CAMARILLO CA
93012-7864
US

V. Phone/Fax

Practice location:
  • Phone: 818-597-2153
  • Fax:
Mailing address:
  • Phone: 559-444-3032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number250186578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: