Provider Demographics
NPI:1649402827
Name:ORTEGA, DIANE M (CNM)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 W BETHANY HOME RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-1953
Mailing Address - Country:US
Mailing Address - Phone:602-973-3200
Mailing Address - Fax:
Practice Address - Street 1:2045 S VINEYARD
Practice Address - Street 2:SUITE 136
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6889
Practice Address - Country:US
Practice Address - Phone:480-565-5990
Practice Address - Fax:623-208-7666
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP3396367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife