Provider Demographics
NPI:1225357015
Name:ORTEGA, AVELENA-ROSE J (RN)
Entity Type:Individual
Prefix:MS
First Name:AVELENA-ROSE
Middle Name:J
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:AVELENA-ROSE
Other - Middle Name:J
Other - Last Name:CARDILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2211 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2745
Mailing Address - Country:US
Mailing Address - Phone:505-272-2111
Mailing Address - Fax:
Practice Address - Street 1:5901 ZUNI RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3073
Practice Address - Country:US
Practice Address - Phone:505-272-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-69778163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse