Provider Demographics
NPI:1326438771
Name:PEDRO L. ORTEGA MD PA
Entity Type:Organization
Organization Name:PEDRO L. ORTEGA MD PA
Other - Org Name:CENTRAL FLORIDA PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:L
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-478-0028
Mailing Address - Street 1:3727 N GOLDENROD RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8611
Mailing Address - Country:US
Mailing Address - Phone:407-478-0028
Mailing Address - Fax:407-476-0297
Practice Address - Street 1:3727 N GOLDENROD RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8611
Practice Address - Country:US
Practice Address - Phone:407-478-0028
Practice Address - Fax:407-476-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009320800Medicaid
FL009320800Medicaid