Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043523624 |
---|---|
Provider Name | Lorena Mayra Ortiz |
First Address | Lompoc, CA 90201 |
Second Address | Lompoc, CA 93436-1923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2010 |
Last Update Date | 23/07/2010 |