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General NPI Number Information
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NPI Number | 1609075605
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Entity Type | Organization
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Legal Business Name | PHILLIP J. ORTIZ, A DENTAL CORPORATION
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 40613 VIA DIAMANTE
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City | MURRIETA
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State | CA
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Zip | 92562-8504
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Country | US
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Telephone | 951-461-9024
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Fax | 951-461-9025
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Provider Business Mailing Address
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Address Line | 40613 VIA DIAMANTE
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City | MURRIETA
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State | CA
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Zip | 92562-8504
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Country | US
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Telephone | 951-461-9024
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Fax | 951-461-9025
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILLIP JOHN ORTIZ
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Credential | DDS
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Telephone | 951-461-9024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 30441
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License Number State | CA
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