Provider Demographics
NPI:1245561158
Name:ORTIZ, ALMA LILIA (DENTAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:LILIA
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-4906
Mailing Address - Country:US
Mailing Address - Phone:323-906-4574
Mailing Address - Fax:
Practice Address - Street 1:4149 TWEEDY BLVD STE J
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6167
Practice Address - Country:US
Practice Address - Phone:323-567-3333
Practice Address - Fax:323-567-2929
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4490748126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant