Provider Demographics
NPI:1811024482
Name:ORTEGA, EDITH BERENICE
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:BERENICE
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 1:1454 JEAN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1428
Mailing Address - Country:US
Mailing Address - Phone:510-393-8325
Mailing Address - Fax:
Practice Address - Street 1:27845 WHITMAN ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-4752
Practice Address - Country:US
Practice Address - Phone:510-461-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health