=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376708602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH NEIL ORTEGO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2008
-----------------------------------------------------
Last Update Date | 07/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 N. LA BREA AVE, STE 201 INGLEWOOD PAROLE CLINICS 4 & 6
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90301-1769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-412-6134
-----------------------------------------------------
Fax | 310-412-6355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 307 W. FOURTH ST REGION II POC
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-412-6134
-----------------------------------------------------
Fax | 310-412-6355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 45241
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------