Provider Demographics
NPI:1518410240
Name:ORTEGA, LEONARDO (BA)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-3948
Mailing Address - Country:US
Mailing Address - Phone:818-216-0429
Mailing Address - Fax:
Practice Address - Street 1:2116 5TH ST
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-3948
Practice Address - Country:US
Practice Address - Phone:818-216-0429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician