Provider Demographics
NPI:1689423576
Name:ORTIZ OSEGUERA, MONICA P
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:P
Last Name:ORTIZ OSEGUERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 WALL ST # 514
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4531
Mailing Address - Country:US
Mailing Address - Phone:562-293-7623
Mailing Address - Fax:
Practice Address - Street 1:1130 WALL ST # 514
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4531
Practice Address - Country:US
Practice Address - Phone:562-293-7623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician