Provider Demographics
NPI:1902976046
Name:TULLIUS, MARITES ORTALIZA (RN NP)
Entity Type:Individual
Prefix:MRS
First Name:MARITES
Middle Name:ORTALIZA
Last Name:TULLIUS
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:MISS
Other - First Name:MARITES
Other - Middle Name:SORIANO
Other - Last Name:ORTALIZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5229 BALBOA BLVD
Mailing Address - Street 2:UNIT 13
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:61316-2723
Mailing Address - Country:US
Mailing Address - Phone:818-788-3169
Mailing Address - Fax:
Practice Address - Street 1:14445 OLIVE VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:SYCMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1495
Practice Address - Country:US
Practice Address - Phone:818-364-3205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16735363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner