Basic Information
| Provider Information | |||||||||
| NPI: | 1982254322 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ORTIZ | ||||||||
| FirstName: | TABITHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1832 ESTANCIA DR | ||||||||
| Address2: | |||||||||
| City: | HUGHSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953269163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099694050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1205 E NORTH ST | ||||||||
| Address2: | |||||||||
| City: | MANTECA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953364932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098233111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2019 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SC1501X | 549487 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Community Health/Public Health | 163W00000X | 95066523 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.