Healthcare Provider Details

I. General information

NPI: 1225711773
Provider Name (Legal Business Name): MISS AMBER MARIE ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 1ST ST
NAPA CA
94559-2239
US

IV. Provider business mailing address

50 RIVER RD SPC 68
RIO VISTA CA
94571-1223
US

V. Phone/Fax

Practice location:
  • Phone: 707-255-1855
  • Fax:
Mailing address:
  • Phone: 707-384-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: