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General NPI Number Information
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NPI Number | 1063173102
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Entity Type | Individual
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Provider Name | NORA NICKOEL B ORTEGA
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Gender | Female
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Dates
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Enumeration Date | 12/30/2021
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 1612 1ST ST
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City | COACHELLA
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State | CA
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Zip | 92236-1407
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Country | US
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Telephone | 760-398-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 86132 CALLE BOUGANVILIA
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City | COACHELLA
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State | CA
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Zip | 92236-2234
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Country | US
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Telephone | 442-324-6867
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APCC10462
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License Number State | CA
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