Provider Demographics
NPI:1215687819
Name:ORTIZ, REGIN CLENN (CLS)
Entity type:Individual
Prefix:
First Name:REGIN CLENN
Middle Name:
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 TOWNSITE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5566
Mailing Address - Country:US
Mailing Address - Phone:760-586-1015
Mailing Address - Fax:
Practice Address - Street 1:846 TOWNSITE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5566
Practice Address - Country:US
Practice Address - Phone:760-586-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTA01006386246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory