Provider Demographics
NPI:1699385302
Name:ORTIGUERO, MONIQUE LEIZA (MSN,FNP-C)
Entity Type:Individual
Prefix:
First Name:MONIQUE LEIZA
Middle Name:
Last Name:ORTIGUERO
Suffix:
Gender:F
Credentials:MSN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 W 169TH PL
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-2827
Mailing Address - Country:US
Mailing Address - Phone:424-216-0233
Mailing Address - Fax:
Practice Address - Street 1:3731 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-2401
Practice Address - Country:US
Practice Address - Phone:323-222-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95014731OtherAANP