Provider Demographics
NPI:1073665998
Name:ORTIZ, TERESA SIFUENTES (FNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:SIFUENTES
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-3116
Mailing Address - Country:US
Mailing Address - Phone:323-981-2930
Mailing Address - Fax:323-981-2935
Practice Address - Street 1:5015 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-3116
Practice Address - Country:US
Practice Address - Phone:323-981-2930
Practice Address - Fax:323-981-2935
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP7205372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP0072050Medicaid