Provider Demographics
NPI:1912259565
Name:ORTTEL, CHER'RYLL
Entity Type:Individual
Prefix:MS
First Name:CHER'RYLL
Middle Name:
Last Name:ORTTEL
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 1:1345 FIGUEROA PL APT 4-23
Mailing Address - Street 2:4-23
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2348
Mailing Address - Country:US
Mailing Address - Phone:310-507-3797
Mailing Address - Fax:
Practice Address - Street 1:921 S BEACON ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3740
Practice Address - Country:US
Practice Address - Phone:310-547-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-06
Last Update Date:2012-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program