Provider Demographics
NPI:1205444296
Name:ORTEGA, KIMBERLY CATY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CATY
Last Name:ORTEGA
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 1:3651 BELL BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2025
Mailing Address - Country:US
Mailing Address - Phone:718-819-8623
Mailing Address - Fax:347-836-8305
Practice Address - Street 1:3651 BELL BLVD STE 209
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2025
Practice Address - Country:US
Practice Address - Phone:718-819-8623
Practice Address - Fax:347-836-8305
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator