Provider Demographics
NPI:1679524854
Name:ORTIZ-SINGH, JANICE C (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:C
Last Name:ORTIZ-SINGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:C
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:150 TEJAS PL
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9123
Mailing Address - Country:US
Mailing Address - Phone:805-929-3211
Mailing Address - Fax:805-929-6440
Practice Address - Street 1:1050 LAS TABLAS RD
Practice Address - Street 2:SUITE 16
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9729
Practice Address - Country:US
Practice Address - Phone:805-434-1038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1508AOtherINDIVIDUAL PTAN WA96529C/ GROUP
MI4792205Medicaid
MI4792180Medicaid
CAW1508OtherGROUP PTAN
MI4792152Medicaid
MI4792170Medicaid
MI4792180Medicaid
CAI46398Medicare PIN
CAW1508OtherGROUP PTAN