Provider Demographics
NPI:1891334363
Name:ORTEZA, TIFFANY (RPH)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:ORTEZA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-3013
Mailing Address - Country:US
Mailing Address - Phone:562-428-2821
Mailing Address - Fax:562-428-2785
Practice Address - Street 1:6000 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-3013
Practice Address - Country:US
Practice Address - Phone:562-428-2821
Practice Address - Fax:562-428-2785
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist