Provider Demographics
NPI:1225114937
Name:ORTEGA, MANUEL DE PERIO JR
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:DE PERIO
Last Name:ORTEGA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S VERMONT AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1912
Mailing Address - Country:US
Mailing Address - Phone:213-738-2744
Mailing Address - Fax:213-427-6178
Practice Address - Street 1:550 S VERMONT AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1912
Practice Address - Country:US
Practice Address - Phone:213-738-2744
Practice Address - Fax:213-427-6178
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator