Provider Demographics
NPI:1841735131
Name:ORTEGA, AUSTIN PAUL
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:PAUL
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AUSTIN
Other - Middle Name:PAUL
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:6601 BLUEWATER RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73165-9651
Mailing Address - Country:US
Mailing Address - Phone:405-517-4840
Mailing Address - Fax:
Practice Address - Street 1:6601 BLUEWATER RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73165-9651
Practice Address - Country:US
Practice Address - Phone:405-517-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker