Active NPI
Michelle Ortega, SUDRC
- Addiction (Substance Use Disorder) Counselor
- Fairfield, CA
National Provider Identifier
1366978124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 12803
- Practice address
- 710 Missouri St
Fairfield, CA 94533-6251 - Phone
- (707) 399-9190
- NPI assigned
- May 11, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 12803 | CA | Primary |
Addresses
Primary practice location
710 Missouri St
Fairfield, CA 94533-6251
Mailing address
2100 Napa Vallejo Hwy BLDG 253M1M2
Napa, CA 94558-6234
Phone (707) 255-8001
Other practice location 1
2100 Napa Vallejo Hwy # M2M3
Napa, CA 94558-6234
Phone (707) 255-8001
Other practice location 2
1515 Market Ave
San Pablo, CA 94806-4357
Phone (510) 232-7571
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R1255450617 | Other | CA | CALIFORNIA |
| 1265560130 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12803 | CA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1657756800000",
"number": "1366978124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 NAPA VALLEJO HWY BLDG 253M1M2",
"city": "NAPA",
"state": "CA",
"postal_code": "945586234",
"telephone_number": "707-255-8001",
"fax_number": "707-255-8006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "710 MISSOURI ST",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945336251",
"telephone_number": "707-399-9190"
}
],
"practiceLocations": [
{
"address_1": "2100 Napa Vallejo Hwy # M2M3",
"address_purpose": "LOCATION",
"city": "Napa",
"state": "CA",
"postal_code": "945586234",
"country_code": "US",
"telephone_number": "707-255-8001",
"fax_number": "707-255-8006",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1515 Market Ave",
"address_purpose": "LOCATION",
"city": "San Pablo",
"state": "CA",
"postal_code": "948064357",
"country_code": "US",
"telephone_number": "510-232-7571",
"fax_number": "510-235-2545",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ORTEGA",
"first_name": "MICHELLE",
"name_prefix": "Mrs.",
"credential": "SUDRC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-11",
"last_updated": "2022-07-14",
"certification_date": "2022-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "12803",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA",
"identifier": "R1255450617",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1265560130",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.