Provider Demographics
NPI:1801809504
Name:ORMAZABAL, AMAYA (MD)
Entity type:Individual
Prefix:
First Name:AMAYA
Middle Name:
Last Name:ORMAZABAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 ZION AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2507
Mailing Address - Country:US
Mailing Address - Phone:619-528-5538
Mailing Address - Fax:
Practice Address - Street 1:4647 ZION AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2507
Practice Address - Country:US
Practice Address - Phone:619-528-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1392622085P0229X, 2085R0202X
WAMD000454912085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00331196OtherRR MEDICARE-TRA
WA8450652Medicaid
WA8859832OtherMEDICARE PIN-TRA KING
WA0208739OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WA8859833OtherMEDICARE PIN-UNION AVENUE OPEN MRI
WA0208244OtherLABOR AND INDUSTRIES-TRA
WA8951844OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WA8941285OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
WA0249564OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WAG8882925OtherPTAN-MIO1
WA8859835OtherMEDICARE PIN-TRA PIERCE