Provider Demographics
NPI:1457577439
Name:ORTEGA, LIA CAROLINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIA
Middle Name:CAROLINA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 EARNSCLIFF PL
Mailing Address - Street 2:APPT. 18
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-4157
Mailing Address - Country:US
Mailing Address - Phone:858-874-7619
Mailing Address - Fax:
Practice Address - Street 1:219 E 8TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2224
Practice Address - Country:US
Practice Address - Phone:619-474-4695
Practice Address - Fax:619-474-2984
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA544471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice