Healthcare Provider Details

I. General information

NPI: 1235744392
Provider Name (Legal Business Name): LANNI LAURA ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 HIGHWAY 202
TEHACHAPI CA
93561-5558
US

IV. Provider business mailing address

819 ASPEN DR # A
TEHACHAPI CA
93561-2125
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-6840
  • Fax:
Mailing address:
  • Phone: 661-238-5987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115823
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: