Provider Demographics
NPI:1255308060
Name:ORTEGA, ALBA JUANITA (MD)
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:JUANITA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:440-960-6500
Mailing Address - Fax:440-960-6515
Practice Address - Street 1:3600 KOLBE RD
Practice Address - Street 2:STE 209
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1654
Practice Address - Country:US
Practice Address - Phone:440-960-6500
Practice Address - Fax:440-960-6515
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.076317208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2134363Medicaid
OH3025372Medicaid
OH2134363Medicaid
OH3025372Medicaid