Provider Demographics
NPI:1568113140
Name:ORTA, TOSHIANNA (CLIA WAIVED)
Entity Type:Individual
Prefix:
First Name:TOSHIANNA
Middle Name:
Last Name:ORTA
Suffix:
Gender:F
Credentials:CLIA WAIVED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18903 BRESCIA LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-1919
Mailing Address - Country:US
Mailing Address - Phone:832-382-6672
Mailing Address - Fax:
Practice Address - Street 1:8628 1/2 LONG POINT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3002
Practice Address - Country:US
Practice Address - Phone:832-382-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory