Healthcare Provider Details

I. General information

NPI: 1346753076
Provider Name (Legal Business Name): MARRY JACQUELINE ORTEGA LICENSED MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N TUSTIN AVE STE 225
SANTA ANA CA
92705-8688
US

IV. Provider business mailing address

1401 N TUSTIN AVE STE 225
SANTA ANA CA
92705-8688
US

V. Phone/Fax

Practice location:
  • Phone: 714-221-6400
  • Fax:
Mailing address:
  • Phone: 714-221-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number129712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: