Provider Demographics
NPI:1568525756
Name:ORTEGA-TICZON, LOURDES REYES (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:REYES
Last Name:ORTEGA-TICZON
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2498 DOUGLASTON GLN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-1464
Mailing Address - Country:US
Mailing Address - Phone:619-855-8273
Mailing Address - Fax:951-698-1132
Practice Address - Street 1:39525 LOS ALAMOS RD STE E
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5027
Practice Address - Country:US
Practice Address - Phone:951-719-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6038171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist