Provider Demographics
NPI:1144663956
Name:ORTEGA-GONZALEZ, JOCELYNN MARIE (DMD)
Entity type:Individual
Prefix:
First Name:JOCELYNN
Middle Name:MARIE
Last Name:ORTEGA-GONZALEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JOCELYNN
Other - Middle Name:MARIE
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:426 ENCLAVE CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-8279
Mailing Address - Country:US
Mailing Address - Phone:305-553-6010
Mailing Address - Fax:
Practice Address - Street 1:8405 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3401
Practice Address - Country:US
Practice Address - Phone:323-653-8622
Practice Address - Fax:323-658-6773
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63888122300000X
FLDN20253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist