Healthcare Provider Details

I. General information

NPI: 1144059122
Provider Name (Legal Business Name): DAHLA-ORTIZ PROFESSIONAL HEALTHCARE CONSULTATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WILDFLOWER DR
ROCHESTER NY
14623-4332
US

IV. Provider business mailing address

PO BOX 251
SANTA CLARA CA
95052-0251
US

V. Phone/Fax

Practice location:
  • Phone: 408-896-3215
  • Fax:
Mailing address:
  • Phone: 408-896-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIANELA ORTIZ-CHAVES DAHLA
Title or Position: GENERAL PARTNER DIRECTOR
Credential: HMA MHA
Phone: 408-896-3215