Provider Demographics
NPI:1427745447
Name:ORTEGA, LETICIA ISABEL (NP)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:ISABEL
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:ISABEL
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16155 SIERRA LAKES PKWY # 160-349
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6833 INDIANA AVE STE 101
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4223
Practice Address - Country:US
Practice Address - Phone:657-346-6319
Practice Address - Fax:951-269-4184
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024867363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner