Provider Demographics
NPI:1578078952
Name:ORTEGA, JOANNE MARIE (LAB TECHNICIAN)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:MARIE
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:LAB TECHNICIAN
Other - Prefix:MS
Other - First Name:JOANNE
Other - Middle Name:MARIE
Other - Last Name:REDONDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAB TECHNICIAN
Mailing Address - Street 1:8296 FIRECRACKER TRL
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-8204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8296 FIRECRACKER TRL
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817
Practice Address - Country:US
Practice Address - Phone:619-371-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126900000XDental ProvidersDental Laboratory Technician