Healthcare Provider Details

I. General information

NPI: 1457401473
Provider Name (Legal Business Name): JULIA ORTEGA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 COLT PL UNIT 103
CARLSBAD CA
92009-1817
US

IV. Provider business mailing address

6180 COLT PL UNIT 103
CARLSBAD CA
92009-1817
US

V. Phone/Fax

Practice location:
  • Phone: 240-888-6486
  • Fax: 410-379-3591
Mailing address:
  • Phone: 404-980-1762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA54197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: