Provider Demographics
NPI:1881065290
Name:ORTIZ, ILIANA YANET (RDA REGISTERED DENTA)
Entity type:Individual
Prefix:MRS
First Name:ILIANA
Middle Name:YANET
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:RDA REGISTERED DENTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E. COLUMBIA ST.
Mailing Address - Street 2:SUITE 32
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1620
Mailing Address - Country:US
Mailing Address - Phone:562-933-3141
Mailing Address - Fax:562-933-2049
Practice Address - Street 1:455 E. COLUMBIA ST.
Practice Address - Street 2:SUITE 32
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1620
Practice Address - Country:US
Practice Address - Phone:562-933-3141
Practice Address - Fax:562-933-2049
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55579126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant