Healthcare Provider Details

I. General information

NPI: 1265096358
Provider Name (Legal Business Name): MAIRA CRISTINA ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31772 CASINO DR STE B
LAKE ELSINORE CA
92530-4502
US

IV. Provider business mailing address

2011 SUNPARK DR
PERRIS CA
92570-9322
US

V. Phone/Fax

Practice location:
  • Phone: 951-409-5297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number138970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: