Provider Demographics
NPI:1982934212
Name:ORTEGA, JAIME (LVN)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 WHITE RANCH CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4742
Mailing Address - Country:US
Mailing Address - Phone:714-231-7757
Mailing Address - Fax:951-735-0172
Practice Address - Street 1:982 WHITE RANCH CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-4742
Practice Address - Country:US
Practice Address - Phone:714-231-7757
Practice Address - Fax:951-735-0172
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 162693164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse