Healthcare Provider Details

I. General information

NPI: 1063065506
Provider Name (Legal Business Name): PEDRO A ORTA II MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 BARTON RD
REDLANDS CA
92373-1488
US

IV. Provider business mailing address

949 MAYO ST
LOS ANGELES CA
90042-3147
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-9532
  • Fax:
Mailing address:
  • Phone: 352-875-6376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA180355
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA180355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: