Healthcare Provider Details

I. General information

NPI: 1730043209
Provider Name (Legal Business Name): STEPHEN LINDSEY-ORTEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W OLYMPIC BLVD STE 401
LOS ANGELES CA
90036-4669
US

IV. Provider business mailing address

5901 W OLYMPIC BLVD STE 401
LOS ANGELES CA
90036-4669
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-9017
  • Fax:
Mailing address:
  • Phone: 310-651-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: