Basic Information
Provider Information
NPI: 1033558085
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ORTEGA
FirstName: LINDA
MiddleName: TANG
NamePrefix: DR.
NameSuffix:  
Credential: PHARM.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 23965 IRONWOOD AVE
Address2:  
City: MORENO VALLEY
State: CA
PostalCode: 925577153
CountryCode: US
TelephoneNumber: 9512421742
FaxNumber: 9512427291
Practice Location
Address1: 23965 IRONWOOD AVE
Address2:  
City: MORENO VALLEY
State: CA
PostalCode: 925577153
CountryCode: US
TelephoneNumber: 9512421742
FaxNumber: 9512427291
Other Information
ProviderEnumerationDate: 06/22/2013
LastUpdateDate: 06/22/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X66486CAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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