Individual provider Active NPI

Marites Ortaliza Tullius, RN NP

  • Nurse Practitioner
  • Sycmar, CA
National Provider Identifier
1902976046
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
16735 Issued in CA
Practice address
14445 Olive View Drive
Sycmar, CA 91342-1495
Phone
(818) 364-3205
NPI assigned
Nov 8, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 16735 CA Primary

Addresses

Primary practice location

14445 Olive View Drive
Sycmar, CA 91342-1495

Mailing address

5229 Balboa Blvd
Unit 13
Encino, CA 61316-2723
Phone (818) 788-3169

Other names 1

  • Miss Marites Soriano Ortaliza Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140320001772 CA Practitioner - Nurse Practitioner 9830339779 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles Auditor Controller CurrentSince Jan 25, 2014 Accepting new patients
County of Los Angeles CurrentSince Jan 25, 2014 Accepting new patients
County of Los Angeles Current Accepting new patients

Locations

14445 Olive View Dr
Sylmar, CA 91342
Phone (881) 836-4303

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902976046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5229 BALBOA BLVD",
            "address_2": "UNIT 13",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "613162723",
            "telephone_number": "818-788-3169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14445 OLIVE VIEW DRIVE",
            "city": "SYCMAR",
            "state": "CA",
            "postal_code": "913421495",
            "telephone_number": "818-364-3205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULLIUS",
        "first_name": "MARITES",
        "middle_name": "ORTALIZA",
        "name_prefix": "Mrs.",
        "credential": "RN NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "16735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARITES",
            "last_name": "ORTALIZA",
            "middle_name": "SORIANO",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Sources for this page

Verify at the official NPI Registry.