Provider Demographics
NPI:1891984688
Name:RICARDO ORTEGA MD, LLC
Entity Type:Organization
Organization Name:RICARDO ORTEGA MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-833-5091
Mailing Address - Street 1:5519 RABADI CASTLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1412
Mailing Address - Country:US
Mailing Address - Phone:505-833-5091
Mailing Address - Fax:505-352-6857
Practice Address - Street 1:5519 RABADI CASTLE AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1412
Practice Address - Country:US
Practice Address - Phone:505-833-5091
Practice Address - Fax:505-352-6857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81-280207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCS00008264OtherNM STATE PHARMACY #
NM81-280OtherNM STATE LICENSE
NM81-280OtherNM STATE LICENSE
NME12632Medicare UPIN
NMAO1187889OtherDEA