Healthcare Provider Details

I. General information

NPI: 1427716604
Provider Name (Legal Business Name): BILL ORTEGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 HARRISON ST
RIVERSIDE CA
92503-3523
US

IV. Provider business mailing address

10984 LEMONWOOD CIR
MORENO VALLEY CA
92557-4028
US

V. Phone/Fax

Practice location:
  • Phone: 951-602-3462
  • Fax: 951-358-4797
Mailing address:
  • Phone: 626-848-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95123360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: