Provider Demographics
NPI:1972750677
Name:ORTEGA, ALEXIS M (COTA/L)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:M
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N ARIZONA AVE APT 1063
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7197
Mailing Address - Country:US
Mailing Address - Phone:480-291-2090
Mailing Address - Fax:
Practice Address - Street 1:110 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5818
Practice Address - Country:US
Practice Address - Phone:480-668-1917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4143171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor