Healthcare Provider Details

I. General information

NPI: 1801643804
Provider Name (Legal Business Name): MARIA TERESA ORNELAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 RIO LINDO AVE
CHICO CA
95926-1816
US

IV. Provider business mailing address

169 PRYDE AVE
BIGGS CA
95917-9709
US

V. Phone/Fax

Practice location:
  • Phone: 530-345-1306
  • Fax:
Mailing address:
  • Phone: 530-301-7206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number52507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: