Provider Demographics
NPI:1487361705
Name:ORTEGA, OTERA (CADC-1)
Entity type:Individual
Prefix:
First Name:OTERA
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:CADC-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37106 TUCANA PL
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2833
Mailing Address - Country:US
Mailing Address - Phone:951-331-9463
Mailing Address - Fax:
Practice Address - Street 1:28400 MCCALL BLVD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-9658
Practice Address - Country:US
Practice Address - Phone:866-284-8724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI29820620101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)