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General NPI Number Information
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NPI Number | 1588061501
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Entity Type | Individual
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Provider Name | SALLY ORTEGA PA
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Gender | Female
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 7301 TOPANGA CANYON BLVD 330
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City | CANOGA PARK
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State | CA
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Zip | 91303-1357
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Country | US
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Telephone | 844-968-6363
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Fax | 818-356-4380
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Provider Business Mailing Address
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Address Line | 1130 GRAND AVE
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City | SAN DIEGO
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State | CA
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Zip | 92109-4120
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Country | US
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Telephone | 573-578-0663
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Fax | 818-356-4380
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 52165
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License Number State | CA
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