Provider Demographics
NPI:1801643804
Name:ORNELAS, MARIA TERESA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:ORNELAS
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 1:169 PRYDE AVE
Mailing Address - Street 2:
Mailing Address - City:BIGGS
Mailing Address - State:CA
Mailing Address - Zip Code:95917-9709
Mailing Address - Country:US
Mailing Address - Phone:530-301-7206
Mailing Address - Fax:
Practice Address - Street 1:587 RIO LINDO AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1816
Practice Address - Country:US
Practice Address - Phone:530-345-1306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52507225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant