Provider Demographics
NPI:1285655068
Name:ORTEGA, ROSE
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 S SAINT VRAIN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901
Mailing Address - Country:US
Mailing Address - Phone:915-534-7979
Mailing Address - Fax:915-534-7601
Practice Address - Street 1:721 S OCHOA
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901
Practice Address - Country:US
Practice Address - Phone:915-545-7190
Practice Address - Fax:915-533-4878
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0849208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G0374Medicare ID - Type Unspecified