Provider Demographics
NPI:1205313020
Name:ORTEGA, LEILA PEARL (RN)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:PEARL
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LEILA
Other - Middle Name:PEARL
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:409 PARKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60073-3138
Mailing Address - Country:US
Mailing Address - Phone:224-475-3824
Mailing Address - Fax:
Practice Address - Street 1:3002 GRAND AVE # ATP
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2321
Practice Address - Country:US
Practice Address - Phone:847-377-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041357635163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)