Provider Demographics
NPI:1275765075
Name:ORTEGA, ROSA MARIA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 HAWAIIAN HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-6938
Mailing Address - Country:US
Mailing Address - Phone:702-614-8766
Mailing Address - Fax:
Practice Address - Street 1:1477 HAWAIIAN HILLS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-6938
Practice Address - Country:US
Practice Address - Phone:702-614-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2000397-571253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care