Healthcare Provider Details

I. General information

NPI: 1972925469
Provider Name (Legal Business Name): ANNETTE ORTEGA ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E 7TH ST
MADERA CA
93638-3780
US

IV. Provider business mailing address

PO BOX 1288
MADERA CA
93639-1288
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-3508
  • Fax:
Mailing address:
  • Phone: 559-673-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116110
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW116110
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: