Healthcare Provider Details

I. General information

NPI: 1972211993
Provider Name (Legal Business Name): JOSE ORTEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N STATE COLLEGE BLVD STE G
ANAHEIM CA
92806-2932
US

IV. Provider business mailing address

444 N BEGONIA AVE
ONTARIO CA
91762-2508
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-6596
  • Fax:
Mailing address:
  • Phone: 909-334-0266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number52239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: