Provider Demographics
NPI:1104373802
Name:ORTEGA, YVONNE (MS, RDN, CSSD)
Entity Type:Individual
Prefix:PROF
First Name:YVONNE
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MS, RDN, CSSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S PROSPECT AVE
Mailing Address - Street 2:UNIT 202
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4462
Mailing Address - Country:US
Mailing Address - Phone:310-213-7856
Mailing Address - Fax:
Practice Address - Street 1:615 S PROSPECT AVE
Practice Address - Street 2:UNIT 202
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4462
Practice Address - Country:US
Practice Address - Phone:310-213-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA895631133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education