Provider Demographics
NPI:1710120217
Name:ORTEGA, OMAR O (RT)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:O
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-0275
Mailing Address - Country:US
Mailing Address - Phone:787-438-5824
Mailing Address - Fax:
Practice Address - Street 1:3 CALLE BETANCES
Practice Address - Street 2:EDIFICIO ROSSY
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-3200
Practice Address - Country:US
Practice Address - Phone:787-871-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2194247100000X
PR#872471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy