Provider Demographics
NPI:1194299727
Name:SANCHEZ-ORTEGA, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SANCHEZ-ORTEGA
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 1:23413 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3028
Mailing Address - Country:US
Mailing Address - Phone:818-898-1388
Mailing Address - Fax:
Practice Address - Street 1:23413 LYONS AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-3028
Practice Address - Country:US
Practice Address - Phone:818-898-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2021-05-17
Deactivation Date:2019-04-30
Deactivation Code:
Reactivation Date:2020-12-08
Provider Licenses
StateLicense IDTaxonomies
CAAMFT120372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6758Medicaid
CA7068Medicaid
CA7420Medicaid