Healthcare Provider Details

I. General information

NPI: 1003123134
Provider Name (Legal Business Name): MARU CEDRIK ORTEGA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44900 WINCHESTER RD
TEMECULA CA
92590
US

IV. Provider business mailing address

44900 WINCHESTER RD
TEMECULA CA
92590-2579
US

V. Phone/Fax

Practice location:
  • Phone: 800-323-6832
  • Fax: 855-270-7347
Mailing address:
  • Phone: 800-323-6832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: