Provider Demographics
NPI:1477799682
Name:EVELYN A ORTEGA MD INC
Entity Type:Organization
Organization Name:EVELYN A ORTEGA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-960-2771
Mailing Address - Street 1:PO BOX 1611
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91793-1611
Mailing Address - Country:US
Mailing Address - Phone:626-960-2771
Mailing Address - Fax:626-960-8112
Practice Address - Street 1:910 S SUNSET AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3409
Practice Address - Country:US
Practice Address - Phone:626-960-2771
Practice Address - Fax:626-960-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty