Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 106S00000X | Behavior Technician |
NPI | 1003386715 |
---|---|
Provider Name | Richard Jesus Ortega |
First Address | Modesto, CA 95355-1582 |
Second Address | Stockton, CA 95202-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2018 |
Last Update Date | 02/06/2021 |