Provider Demographics
NPI:1104639178
Name:ORTIZ CUESTA, MATEO EZEQUIEL
Entity type:Individual
Prefix:
First Name:MATEO
Middle Name:EZEQUIEL
Last Name:ORTIZ CUESTA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-3602
Mailing Address - Country:US
Mailing Address - Phone:707-941-0859
Mailing Address - Fax:844-388-6167
Practice Address - Street 1:101 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3602
Practice Address - Country:US
Practice Address - Phone:707-941-0859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist