Provider Demographics
NPI:1467890772
Name:ORTEGA, LAURO IVAN (MD)
Entity Type:Individual
Prefix:
First Name:LAURO
Middle Name:IVAN
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 N FESTIVAL DR., VILLA G
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2709
Mailing Address - Country:US
Mailing Address - Phone:915-845-4024
Mailing Address - Fax:
Practice Address - Street 1:154 N FESTIVAL DR., VILLA G
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2709
Practice Address - Country:US
Practice Address - Phone:915-845-4024
Practice Address - Fax:915-845-4019
Is Sole Proprietor?:No
Enumeration Date:2013-06-08
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10047616207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine