Provider Demographics
NPI:1831135409
Name:ORTIZ, DON JUAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:DON
Middle Name:JUAN
Last Name:ORTIZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12823 LUISENO ST
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2008
Mailing Address - Country:US
Mailing Address - Phone:858-592-6540
Mailing Address - Fax:
Practice Address - Street 1:465 COLLEGE BLVD.
Practice Address - Street 2:STE. 1
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057
Practice Address - Country:US
Practice Address - Phone:760-630-8400
Practice Address - Fax:760-630-8594
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17862363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ42921Medicare UPIN