Provider Demographics
NPI:1821232968
Name:JUAN ANTONIO ORTEGA-MORA MD PA
Entity Type:Organization
Organization Name:JUAN ANTONIO ORTEGA-MORA MD PA
Other - Org Name:ORTEGA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:281-740-0856
Mailing Address - Street 1:3313 ORLANDO ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77093-4854
Mailing Address - Country:US
Mailing Address - Phone:713-699-9177
Mailing Address - Fax:
Practice Address - Street 1:3313 ORLANDO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-4854
Practice Address - Country:US
Practice Address - Phone:713-699-9177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3593208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127160302Medicaid
TX127160302Medicaid
TX00JQ74Medicare PIN