Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A52557 | CA |
NPI | 1003948803 |
---|---|
Provider Name | Dr. Marita Fortades |
First Address | Orange, CA 92868-3835 |
Second Address | Orange, CA 92868-3835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |