Provider Demographics
NPI:1699385302
Name:ORTIGUERO, MONIQUE LEIZA P (NP-C)
Entity type:Individual
Prefix:
First Name:MONIQUE LEIZA
Middle Name:P
Last Name:ORTIGUERO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25109 JEFFERSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8117
Mailing Address - Country:US
Mailing Address - Phone:951-698-0440
Mailing Address - Fax:888-696-1496
Practice Address - Street 1:25109 JEFFERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8117
Practice Address - Country:US
Practice Address - Phone:951-698-0440
Practice Address - Fax:888-696-1496
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95014731OtherAANP