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1083185318 NPI number — ALEXIS JANENE ORTEGA

NPI Number: 1083185318
Health Care Provider/Practitioner: ALEXIS JANENE ORTEGA

Information about “1083185318” NPI (ALEXIS JANENE ORTEGA) exists in 1083185318 in HTML format HTML  |  1083185318 in plain Text format TXT  |  1083185318 in PDF (Portable Document Format) PDF  |  1083185318 in an XML format XML  formats.

NPI Number : 1083185318 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083185318",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ORTEGA",
    "FirstName": "ALEXIS",
    "MiddleName": "JANENE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BANKS",
    "OtherFirstName": "ALEXIS",
    "OtherMiddleName": "JANENE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2794 SPRUCE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RIALTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92376-5346",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "951-347-7161",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1461 E COOLEY DR STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLTON",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92324-3921",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "877-527-7227",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/16/2018",
    "LastUpdateDate": "07/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "A066530625",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "175T00000X",
          "TaxonomyName": "Peer Specialist",
          "LicenseNumber": "MPSS-PPSD9C",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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