Provider Demographics
NPI:1710415815
Name:ORTEGA, MARIA G
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3422
Mailing Address - Street 2:
Mailing Address - City:WEST WENDOVER
Mailing Address - State:NV
Mailing Address - Zip Code:89883-3422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:663 N APACHE LN
Practice Address - Street 2:
Practice Address - City:WEST WENDOVER
Practice Address - State:NV
Practice Address - Zip Code:89883-5708
Practice Address - Country:US
Practice Address - Phone:801-793-2162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst