Provider Demographics
NPI:1356385264
Name:ORTEGA, JUAN A (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111428
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77293
Mailing Address - Country:US
Mailing Address - Phone:713-699-9177
Mailing Address - Fax:713-699-4538
Practice Address - Street 1:3313 ORLANDO
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093
Practice Address - Country:US
Practice Address - Phone:713-699-9177
Practice Address - Fax:713-699-4538
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3593208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
JQ74Medicare ID - Type Unspecified
B25298Medicare UPIN