Provider Demographics
NPI:1942063318
Name:ORTEZA, QUEENIE KRYSTAL ANN SALAZAR
Entity Type:Individual
Prefix:
First Name:QUEENIE KRYSTAL ANN
Middle Name:SALAZAR
Last Name:ORTEZA
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 1:3368 METHILHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1360
Mailing Address - Country:US
Mailing Address - Phone:510-646-7170
Mailing Address - Fax:
Practice Address - Street 1:425 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-1936
Practice Address - Country:US
Practice Address - Phone:669-245-3429
Practice Address - Fax:408-550-7433
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator