Provider Demographics
NPI:1104377761
Name:ORTEGA, ORESTES III (HIS)
Entity Type:Individual
Prefix:MR
First Name:ORESTES
Middle Name:
Last Name:ORTEGA
Suffix:III
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 E JOYCE BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5162
Mailing Address - Country:US
Mailing Address - Phone:479-443-6511
Mailing Address - Fax:479-443-7811
Practice Address - Street 1:1970 E JOYCE BLVD
Practice Address - Street 2:STE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5162
Practice Address - Country:US
Practice Address - Phone:479-443-6511
Practice Address - Fax:479-443-7811
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR611237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist