Provider Demographics
NPI:1073844171
Name:ORTIZ, REGINA DEANNA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:DEANNA
Last Name:ORTIZ
Suffix:
Gender:F
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 1:4770 N EXPRESSWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4165
Mailing Address - Country:US
Mailing Address - Phone:956-350-0874
Mailing Address - Fax:
Practice Address - Street 1:4770 N EXPRESSWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4165
Practice Address - Country:US
Practice Address - Phone:956-350-0874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02581363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical