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General NPI Number Information
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NPI Number | 1023453578
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Entity Type | Individual
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Provider Name | BREEANA ORTEGA HERRERA
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Gender | Female
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Dates
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Enumeration Date | 05/09/2013
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 242 W MAIN ST
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City | WILLAMINA
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State | OR
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Zip | 97396
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Country | US
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Telephone | 971-237-2560
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Fax |
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Provider Business Mailing Address
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Address Line | 315 SE HARNEY ST
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City | SHERIDAN
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State | OR
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Zip | 97378-1922
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Country | US
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Telephone | 971-237-2560
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 19524
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License Number State | OR
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