Provider Demographics
NPI:1215124946
Name:ORTEGA, SYLVIA JARAMILLO (PA)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:JARAMILLO
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8735 SIERRA COLLEGE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5992
Mailing Address - Country:US
Mailing Address - Phone:916-773-3376
Mailing Address - Fax:916-773-3353
Practice Address - Street 1:8735 SIERRA COLLEGE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5992
Practice Address - Country:US
Practice Address - Phone:916-773-3376
Practice Address - Fax:916-773-3353
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA19187207N00000X
CA20A7904207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046090Medicaid
CAGR0046090Medicaid
CAI14855Medicare UPIN