Individual
ANTHONY ORTEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
540 S EREMLAND DR, COVINA, CA 91723-3186
(626) 966-1577
Mailing address
540 S EREMLAND DR, COVINA, CA 91723-3186
(626) 966-1577
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7103
MEDI CAL
CA
Enumeration date
02/19/2020
Last updated
02/19/2020
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