Healthcare Provider Details

I. General information

NPI: 1639091101
Provider Name (Legal Business Name): JORDAN ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

13079 VAN NUYS BLVD
PACOIMA CA
91331-2575
US

IV. Provider business mailing address

15555 HUNTINGTON VILLAGE LN APT 24
HUNTINGTON BEACH CA
92647-3044
US

V. Phone/Fax

Practice location:
  • Phone: 818-206-3353
  • Fax:
Mailing address:
  • Phone: 714-887-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSPA9120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: