Provider Demographics
NPI:1457586356
Name:ORTEGA, RAFAELA
Entity Type:Individual
Prefix:
First Name:RAFAELA
Middle Name:
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 1:1751 CLOVERFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4007
Mailing Address - Country:US
Mailing Address - Phone:310-393-8541
Mailing Address - Fax:310-883-1221
Practice Address - Street 1:1751 CLOVERFIELD BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-4007
Practice Address - Country:US
Practice Address - Phone:310-393-8541
Practice Address - Fax:310-883-1221
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health