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General NPI Number Information
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NPI Number | 1720289721
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Entity Type | Individual
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Provider Name | CAMILLE M ORTEGA DDS
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Gender | Female
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 919 E MAIN ST
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City | BARSTOW
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State | CA
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Zip | 92311-2407
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Country | US
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Telephone | 760-256-2425
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Fax |
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Provider Business Mailing Address
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Address Line | 4027 NOOK WAY APT D
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City | LAS VEGAS
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State | NV
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Zip | 89103-2550
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Country | US
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Telephone | 702-499-3242
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 44973
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License Number State | CA
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