Provider Demographics
NPI:1003316761
Name:ORTEGA, LAZARO RENE (RN)
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:RENE
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:LAZARO
Other - Middle Name:RENE
Other - Last Name:ORTEGA OFARRILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:15814 VAL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-3919
Mailing Address - Country:US
Mailing Address - Phone:832-466-7616
Mailing Address - Fax:
Practice Address - Street 1:15814 VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-3919
Practice Address - Country:US
Practice Address - Phone:832-466-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX931144163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse