Provider Demographics
NPI:1275608002
Name:ORTEGO, JAMES A (MA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:ORTEGO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19510 VAN BUREN BLVD STE F3
Mailing Address - Street 2:PMB 114
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9458
Mailing Address - Country:US
Mailing Address - Phone:951-398-9257
Mailing Address - Fax:
Practice Address - Street 1:3833 10TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3519
Practice Address - Country:US
Practice Address - Phone:951-328-2287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46916106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist