Provider Demographics
NPI:1720586522
Name:ORNELAS, ISAAC
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:ORNELAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 W SESAME DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7962
Mailing Address - Country:US
Mailing Address - Phone:956-428-5440
Mailing Address - Fax:956-428-3375
Practice Address - Street 1:1300 WILDROSE LN
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8600
Practice Address - Country:US
Practice Address - Phone:956-542-2845
Practice Address - Fax:956-548-9019
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1232455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist