MEDICARE: LILIA L. ORTEGA RND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility
2	311ZA0620X	Adult Care Home Facility	RN00095259	WA

General Provider Information

NPI Number	:	1366865644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILIA L. ORTEGA RND

Provider Business Mailing Address
First Line	:	3703 COLUMBIA ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98660-1965
Country	:	US
Telephone Number	:	360-521-3776
Fax Number	:	360-750-0133

Provider Business Practice Location Address
First Line	:	3703 COLUMBIA ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98660-1965
Country	:	US
Telephone Number	:	360-521-3776
Fax Number	:	360-750-0133

Authorized Official
Title or Position	:	RN, BSN
Name	:	LILIA L. ORTEGA IX
Credential	:
Telephone Number	:	360-521-3776

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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