Provider Demographics
NPI:1609178896
Name:ORTEGA, REGINO JR
Entity Type:Individual
Prefix:MR
First Name:REGINO
Middle Name:
Last Name:ORTEGA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:REGINO
Other - Middle Name:
Other - Last Name:ORTEGA
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2112 TRAWOOD DR
Mailing Address - Street 2:STE. A-1
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3372
Mailing Address - Country:US
Mailing Address - Phone:915-778-4243
Mailing Address - Fax:
Practice Address - Street 1:2112 TRAWOOD DR
Practice Address - Street 2:STE. A-1
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3372
Practice Address - Country:US
Practice Address - Phone:915-778-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical