Provider Demographics
NPI:1699502799
Name:LUIS ORTEGA, DAMARIZ ITZEL (PTA)
Entity type:Individual
Prefix:
First Name:DAMARIZ
Middle Name:ITZEL
Last Name:LUIS ORTEGA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 W 110TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-4324
Mailing Address - Country:US
Mailing Address - Phone:323-301-2121
Mailing Address - Fax:
Practice Address - Street 1:822 W 110TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4324
Practice Address - Country:US
Practice Address - Phone:323-301-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53529225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant