Healthcare Provider Details

I. General information

NPI: 1316395569
Provider Name (Legal Business Name): OLIVIA MARIE ORTEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 UNIVERSITY AVE STE 120
SACRAMENTO CA
95825-6532
US

IV. Provider business mailing address

1111 EXPOSITION BLVD STE 300
SACRAMENTO CA
95815-4324
US

V. Phone/Fax

Practice location:
  • Phone: 916-426-1969
  • Fax:
Mailing address:
  • Phone: 916-929-8564
  • Fax: 916-929-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberSL1204
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number20A18247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: