Healthcare Provider Details

I. General information

NPI: 1275143851
Provider Name (Legal Business Name): BRIAN ORTEGA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 SHATTUCK AVE
BERKELEY CA
94709-1410
US

IV. Provider business mailing address

532 30TH ST APT 4
OAKLAND CA
94609-3223
US

V. Phone/Fax

Practice location:
  • Phone: 510-849-0484
  • Fax:
Mailing address:
  • Phone: 978-983-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH82264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: