Healthcare Provider Details

I. General information

NPI: 1043687650
Provider Name (Legal Business Name): LORAINE ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 SPRING DR
SPRING VALLEY CA
91977
US

IV. Provider business mailing address

8788 JAMACHA RD.
SPRING VALLEY CA
91977
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2380
  • Fax: 619-713-0480
Mailing address:
  • Phone: 619-515-2380
  • Fax: 619-713-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: