Healthcare Provider Details

I. General information

NPI: 1114821485
Provider Name (Legal Business Name): MISS KATHYA MARIE ORTIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 MORENA BLVD
SAN DIEGO CA
92110-3815
US

IV. Provider business mailing address

3454 CASTLE GLEN DR UNIT 120
SAN DIEGO CA
92123-5448
US

V. Phone/Fax

Practice location:
  • Phone: 619-542-4953
  • Fax:
Mailing address:
  • Phone: 661-523-9221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: