Provider Demographics
NPI:1285844837
Name:ORTEGA, CHARLES E (PAC, MPAS)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:PAC, MPAS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7901 JOHN CARPENTER FWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4832
Mailing Address - Country:US
Mailing Address - Phone:972-382-9992
Mailing Address - Fax:469-802-0070
Practice Address - Street 1:7901 JOHN CARPENTER FWY STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4832
Practice Address - Country:US
Practice Address - Phone:469-578-8240
Practice Address - Fax:469-533-5867
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA02353363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA02353OtherLICENSE
TXP19402OtherMEDICAL LICENSE