Provider Demographics
NPI:1053121954
Name:ORTEGA, VICENTE J
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:J
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 DAWN DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-2516
Mailing Address - Country:US
Mailing Address - Phone:530-848-3883
Mailing Address - Fax:
Practice Address - Street 1:1947 GALILEO CT
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-4882
Practice Address - Country:US
Practice Address - Phone:530-220-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician