Provider Demographics
NPI:1619188638
Name:ORTEGA, RODRIGO (DDS)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RODRIGO
Other - Middle Name:
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:312 N. SOTO ST.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-263-3918
Mailing Address - Fax:
Practice Address - Street 1:312 N SOTO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1815
Practice Address - Country:US
Practice Address - Phone:323-263-3918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice