Individual
TRYSTAN NOEL ORTEGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
401 BROADWAY AVE, PUEBLO, CO 81004-2127
(719) 329-4208
Mailing address
425 W LOOKOUT DR, PUEBLO WEST, CO 81007-3677
(719) 329-4208
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
RBT-21-150639
CO
Other
Enumeration date
05/26/2021
Last updated
05/26/2021
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