Healthcare Provider Details

I. General information

NPI: 1881463024
Provider Name (Legal Business Name): AUGUSTINA ORTIZ-MARQUEZ BSM, LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 1/2 AQUA VISTA ST
STUDIO CITY CA
91602-3106
US

IV. Provider business mailing address

11050 1/2 AQUA VISTA ST
STUDIO CITY CA
91602-3106
US

V. Phone/Fax

Practice location:
  • Phone: 818-434-7031
  • Fax:
Mailing address:
  • Phone: 818-434-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: