Provider Demographics
NPI:1023453578
Name:ORTEGA HERRERA, BREEANA
Entity type:Individual
Prefix:
First Name:BREEANA
Middle Name:
Last Name:ORTEGA HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREEANA
Other - Middle Name:
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:315 SE HARNEY ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:OR
Mailing Address - Zip Code:97378-1922
Mailing Address - Country:US
Mailing Address - Phone:971-237-2560
Mailing Address - Fax:
Practice Address - Street 1:242 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLAMINA
Practice Address - State:OR
Practice Address - Zip Code:97396
Practice Address - Country:US
Practice Address - Phone:971-237-2560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19524174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist