Provider Demographics
NPI:1952490427
Name:ORTEGA, LUCY M (PA)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:M
Last Name:ORTEGA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:2825 E BARNETT RD
Mailing Address - Street 2:MSS
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8332
Mailing Address - Country:US
Mailing Address - Phone:541-789-4281
Mailing Address - Fax:541-789-4806
Practice Address - Street 1:555 BLACK OAK DR.
Practice Address - Street 2:SUITE 400
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8491
Practice Address - Country:US
Practice Address - Phone:541-789-8873
Practice Address - Fax:541-789-2173
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-11-16
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Provider Licenses
StateLicense IDTaxonomies
CAPA16935363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP92605Medicare UPIN