Basic Information
| Provider Information | |||||||||
| NPI: | 1912627183 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTEGA DUBONGCO | ||||||||
| FirstName: | KATRIEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7675 MISSION VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921084429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003166314 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1703 TERMINO AVE STE 206 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908042128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629610210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2022 | ||||||||
| LastUpdateDate: | 08/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F08220312 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.