Provider Demographics
NPI:1225192784
Name:ORTEGA, OSCAR O (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:O
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11318 CLOVERDALE CT SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1234
Mailing Address - Country:US
Mailing Address - Phone:253-588-2489
Mailing Address - Fax:
Practice Address - Street 1:4314 E PORTLAND AVE STE 7
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-4696
Practice Address - Country:US
Practice Address - Phone:253-476-9121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA08722Medicare UPIN