Healthcare Provider Details

I. General information

NPI: 1215867882
Provider Name (Legal Business Name): MOISES FAUSTO ORTEGA NURSING ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44359 PALM ST
INDIO CA
92201-3116
US

IV. Provider business mailing address

44359 PALM ST
INDIO CA
92201-3116
US

V. Phone/Fax

Practice location:
  • Phone: 760-342-6616
  • Fax:
Mailing address:
  • Phone: 760-342-6616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: