Provider Demographics
NPI:1356529945
Name:ORTEGA, JEROMY MILES
Entity type:Individual
Prefix:MR
First Name:JEROMY
Middle Name:MILES
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 466 BOX 3
Mailing Address - Street 2:BHC DIEGO GARCIA
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96595
Mailing Address - Country:US
Mailing Address - Phone:011246-370-4211
Mailing Address - Fax:
Practice Address - Street 1:PSC 466 BOX 3
Practice Address - Street 2:BHC DIEGO GARCIA
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96595
Practice Address - Country:US
Practice Address - Phone:011246-370-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman