Healthcare Provider Details

I. General information

NPI: 1558600429
Provider Name (Legal Business Name): JOSE ORTIZ RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14525 LAKEWOOD BLVD STE A
PARAMOUNT CA
90723-3638
US

IV. Provider business mailing address

11226 MEADOWLARK LN
BLOOMINGTON CA
92316-3266
US

V. Phone/Fax

Practice location:
  • Phone: 562-272-0000
  • Fax:
Mailing address:
  • Phone: 909-519-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number24138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: