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General NPI Number Information
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NPI Number | 1487361705
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Entity Type | Individual
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Provider Name | OTERA ORTEGA CADC-1
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Gender | Female
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 28400 MCCALL BLVD
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City | MENIFEE
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State | CA
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Zip | 92585-9658
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Country | US
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Telephone | 866-284-8724
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Fax |
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Provider Business Mailing Address
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Address Line | 37106 TUCANA PL
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City | MURRIETA
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State | CA
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Zip | 92563-2833
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Country | US
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Telephone | 951-331-9463
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CI29820620
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License Number State | CA
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