Healthcare Provider Details

I. General information

NPI: 1083437727
Provider Name (Legal Business Name): BRYAN ORTEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2259 MYRTLE AVE
EUREKA CA
95501-3325
US

IV. Provider business mailing address

2259 MYRTLE AVE
EUREKA CA
95501-3325
US

V. Phone/Fax

Practice location:
  • Phone: 562-659-3772
  • Fax:
Mailing address:
  • Phone: 707-444-8293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: