Provider Demographics
NPI:1316395569
Name:ORTEZA, OLIVIA MARIE
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIE
Last Name:ORTEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2827
Mailing Address - Country:US
Mailing Address - Phone:916-716-9671
Mailing Address - Fax:
Practice Address - Street 1:333 UNIVERSITY AVE STE 120
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6532
Practice Address - Country:US
Practice Address - Phone:916-426-1969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL1204207R00000X
CA20A18247207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine