Provider Demographics
NPI:1134784887
Name:SANTOS-ORTEGA, LOURDES
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:SANTOS-ORTEGA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWMAN
Mailing Address - State:CA
Mailing Address - Zip Code:95360-1324
Mailing Address - Country:US
Mailing Address - Phone:209-862-2933
Mailing Address - Fax:
Practice Address - Street 1:1223 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWMAN
Practice Address - State:CA
Practice Address - Zip Code:95360-1324
Practice Address - Country:US
Practice Address - Phone:209-862-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2025-05-02
Deactivation Date:2019-11-08
Deactivation Code:
Reactivation Date:2019-11-19
Provider Licenses
StateLicense IDTaxonomies
CA1298241041C0700X
CA96488101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical