MEDICARE: MARINA ORTEGA COLON HYDROTHERAPIST

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	171400000X	Health & Wellness Coach	FFMS215205	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FMS215205	OTHER	AZ	COLON HYDROTHERAPIST- WELLNESS COACH

General Provider Information

NPI Number	:	1932852365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA ORTEGA COLON HYDROTHERAPIST

Provider Business Mailing Address
First Line	:	9030 E ROSEMONTE DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-5358
Country	:	US
Telephone Number	:	602-793-0616
Fax Number	:

Provider Business Practice Location Address
First Line	:	14220 N NORTHSIGHT BLVD STE 150
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-3950
Country	:	US
Telephone Number	:	480-840-7021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	01/26/2022

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