Provider Demographics
NPI:1487029401
Name:DELATORRE-ORDAZ, ANA L (RDH)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:L
Last Name:DELATORRE-ORDAZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10616 NE SISKIYOU ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2770
Mailing Address - Country:US
Mailing Address - Phone:503-740-4497
Mailing Address - Fax:
Practice Address - Street 1:10616 NE SISKIYOU ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-2770
Practice Address - Country:US
Practice Address - Phone:503-740-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7066124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist