Provider Demographics
NPI:1538512744
Name:ORTIZ, AZILA KATHERINE SABILE
Entity Type:Individual
Prefix:MRS
First Name:AZILA KATHERINE
Middle Name:SABILE
Last Name:ORTIZ
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 1:15260 AMALIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-1228
Mailing Address - Country:US
Mailing Address - Phone:858-366-8787
Mailing Address - Fax:858-240-6200
Practice Address - Street 1:15260 AMALIA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-1228
Practice Address - Country:US
Practice Address - Phone:858-366-8787
Practice Address - Fax:858-240-6200
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374602950302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization