Healthcare Provider Details

I. General information

NPI: 1972221984
Provider Name (Legal Business Name): ALEXIS Y ORTEGA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXIS YVONNE ORTEGA NP

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 ROSS AVE
EL CENTRO CA
92243-3685
US

IV. Provider business mailing address

2151 ROSS AVE
EL CENTRO CA
92243-3685
US

V. Phone/Fax

Practice location:
  • Phone: 760-592-4961
  • Fax: 760-592-4964
Mailing address:
  • Phone: 760-592-4961
  • Fax: 760-592-4964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number95022204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: