Provider Demographics
NPI:1649775651
Name:ORTEGO, BRIDGET (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:ORTEGO
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 EUGENE SOILEAU RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70589-4174
Mailing Address - Country:US
Mailing Address - Phone:337-351-4823
Mailing Address - Fax:
Practice Address - Street 1:1049 EUGENE SOILEAU RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:LA
Practice Address - Zip Code:70589-4174
Practice Address - Country:US
Practice Address - Phone:337-351-4823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA970600133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty