Provider Demographics
NPI:1528406766
Name:ORTEGO, ROBERT WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:ORTEGO
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 1:5455 SYLMAR AVE.
Mailing Address - Street 2:SUITE 2302
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:91401-5124
Mailing Address - Country:US
Mailing Address - Phone:818-786-0753
Mailing Address - Fax:
Practice Address - Street 1:5455 SYLMAR AVE.
Practice Address - Street 2:SUITE 2302
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:91401-5124
Practice Address - Country:US
Practice Address - Phone:818-786-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACFE30230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine