Healthcare Provider Details

I. General information

NPI: 1285382333
Provider Name (Legal Business Name): MARTHA ISSAREN ORTIZ VEGA CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA ISSAREN ORTIZ CPC

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NORTHEAST
SEATTLE WA
98105
US

IV. Provider business mailing address

727 55TH ST SW UNIT A
EVERETT WA
98203
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2164
  • Fax:
Mailing address:
  • Phone: 425-328-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: