Healthcare Provider Details

I. General information

NPI: 1093560096
Provider Name (Legal Business Name): CHRISTOPHER RYAN ORTEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 STINE RD APT 17
BAKERSFIELD CA
93309-6322
US

IV. Provider business mailing address

21600 OXNARD ST STE 200
WOODLAND HILLS CA
91367-4971
US

V. Phone/Fax

Practice location:
  • Phone: 661-748-4452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: