Provider Demographics
NPI:1871143586
Name:ORTEGA, ANQUANITTE DARLENE
Entity type:Individual
Prefix:MRS
First Name:ANQUANITTE
Middle Name:DARLENE
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANQUANITTE
Other - Middle Name:DARLENE
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH
Mailing Address - Street 1:1111 BLOSSOM AVE
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-6625
Mailing Address - Country:US
Mailing Address - Phone:707-386-6598
Mailing Address - Fax:707-428-4430
Practice Address - Street 1:1111 BLOSSOM AVE
Practice Address - Street 2:
Practice Address - City:SUISUN CITY
Practice Address - State:CA
Practice Address - Zip Code:94585-6625
Practice Address - Country:US
Practice Address - Phone:707-386-6598
Practice Address - Fax:707-428-4430
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-14
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider