Provider Demographics
NPI:1285382333
Name:ORTIZ VEGA, MARTHA ISSAREN (CPC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ISSAREN
Last Name:ORTIZ VEGA
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ISSAREN
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPC
Mailing Address - Street 1:727 55TH ST SW
Mailing Address - Street 2:UNIT A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203
Mailing Address - Country:US
Mailing Address - Phone:425-328-6792
Mailing Address - Fax:
Practice Address - Street 1:4800 SAND POINT WAY NORTHEAST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-987-2164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist