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General NPI Number Information
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NPI Number | 1003605692
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Entity Type | Individual
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Provider Name | JACOB ORTLINGHAUS EMT-P
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Gender | Male
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Dates
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Enumeration Date | 05/01/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 983 SONOMA AVE
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City | SANTA ROSA
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State | CA
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Zip | 95404-4818
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Country | US
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Telephone | 707-292-3046
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Fax |
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Provider Business Mailing Address
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Address Line | 983 SONOMA AVE
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City | SANTA ROSA
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State | CA
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Zip | 95404-4818
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Country | US
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Telephone | 707-292-3046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | P42872
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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