Provider Demographics
NPI:1114677739
Name:ORTEGA, ADAM JACOB (PA-C)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JACOB
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27141 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-7354
Mailing Address - Country:US
Mailing Address - Phone:956-367-0246
Mailing Address - Fax:
Practice Address - Street 1:5201 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2708
Practice Address - Country:US
Practice Address - Phone:956-631-5411
Practice Address - Fax:956-631-7129
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA15542363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant