Provider Demographics
NPI:1376549477
Name:ORTEGA, CRISTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:30 JORDAN LANE
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1278
Mailing Address - Country:US
Mailing Address - Phone:860-263-0253
Mailing Address - Fax:860-263-0262
Practice Address - Street 1:893 MAIN STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2293
Practice Address - Country:US
Practice Address - Phone:860-528-4124
Practice Address - Fax:860-282-1213
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1376549477OtherNPI
H47018Medicare UPIN
CT080001699Medicare ID - Type Unspecified