1881065290 NPI number — MRS. ILIANA YANET ORTIZ RDA REGISTERED DENTA

Table of content: MRS. ILIANA YANET ORTIZ RDA REGISTERED DENTA (NPI 1881065290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881065290 NPI number — MRS. ILIANA YANET ORTIZ RDA REGISTERED DENTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ
Provider First Name:
ILIANA
Provider Middle Name:
YANET
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RDA REGISTERED DENTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881065290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 E. COLUMBIA ST.
Provider Second Line Business Mailing Address:
SUITE 32
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90806-1620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-933-3141
Provider Business Mailing Address Fax Number:
562-933-2049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 E. COLUMBIA ST.
Provider Second Line Business Practice Location Address:
SUITE 32
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90806-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-933-3141
Provider Business Practice Location Address Fax Number:
562-933-2049
Provider Enumeration Date:
10/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 126800000X , with the licence number:  55579 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com