Provider Demographics
NPI:1013464379
Name:ORTEGA WELLNESS
Entity Type:Organization
Organization Name:ORTEGA WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:505-340-0406
Mailing Address - Street 1:7007 JEFFERSON ST NE SUITE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQEURQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4450
Mailing Address - Country:US
Mailing Address - Phone:505-340-0406
Mailing Address - Fax:505-340-0406
Practice Address - Street 1:1101 GOLF COURSE RD SE
Practice Address - Street 2:SUITE 203
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4731
Practice Address - Country:US
Practice Address - Phone:505-340-0406
Practice Address - Fax:505-340-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-04
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty