Healthcare Provider Details

I. General information

NPI: 1831879345
Provider Name (Legal Business Name): BRYCE ORTEGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1642
US

IV. Provider business mailing address

4370 CHICAGO DR SW STE 735
GRANDVILLE MI
49418-1694
US

V. Phone/Fax

Practice location:
  • Phone: 616-341-7470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: