Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95018947 | CA |
NPI | 1023775939 |
---|---|
Provider Name | Mr. Miguel Ortega |
First Address | Los Angeles, CA 90065-0873 |
Second Address | Los Angeles, CA 90033-1370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2021 |
Last Update Date | 27/11/2021 |