Healthcare Provider Details

I. General information

NPI: 1366865644
Provider Name (Legal Business Name): LILIA L. ORTEGA RND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 COLUMBIA ST
VANCOUVER WA
98660-1965
US

IV. Provider business mailing address

3703 COLUMBIA ST
VANCOUVER WA
98660-1965
US

V. Phone/Fax

Practice location:
  • Phone: 360-521-3776
  • Fax: 360-750-0133
Mailing address:
  • Phone: 360-521-3776
  • Fax: 360-750-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberRN00095259
License Number StateWA

VIII. Authorized Official

Name: LILIA L. ORTEGA IX
Title or Position: RN, BSN
Credential:
Phone: 360-521-3776