Provider Demographics
NPI:1639835168
Name:ORTEGA, RICHARD ALEXANDER
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALEXANDER
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12360 OSBORNE ST UNIT 123
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-2168
Mailing Address - Country:US
Mailing Address - Phone:818-284-5062
Mailing Address - Fax:
Practice Address - Street 1:12360 OSBORNE ST UNIT 123
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-2168
Practice Address - Country:US
Practice Address - Phone:818-284-5062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner