Healthcare Provider Details

I. General information

NPI: 1811443328
Provider Name (Legal Business Name): PRISCILLA MARIE ORTEGA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 W FOOTHILL BLVD SUITE A
UPLAND CA
91786-3772
US

IV. Provider business mailing address

918 W FOOTHILL BLVD SUITE A
UPLAND CA
91786-3772
US

V. Phone/Fax

Practice location:
  • Phone: 909-890-5511
  • Fax: 909-985-0351
Mailing address:
  • Phone: 909-890-5511
  • Fax: 909-985-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number829700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: