Provider Information for 1790934644
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Ms. JESSICA ORTIZ
Sex: Female
NPI: 1790934644
Last Updated: 2013-06-10
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1790934644 | ||||||||
| Enumeration Date | 2008-09-16 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 625 FAIR OAKS AVE SUITE 358 SOUTH PASADENA, CA 91030-2630 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 625 FAIR OAKS AVE SUITE 300 SOUTH PASADENA, CA 91030-2630 United States Phone: 626-395-7100 | Fax: | ||||||||
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