Provider Demographics
NPI:1740274638
Name:ORTEGA, ROGELIO GUILLERMO (MD)
Entity type:Individual
Prefix:
First Name:ROGELIO
Middle Name:GUILLERMO
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:CCI/ CMO OFFICE
Mailing Address - Street 2:PO BOX 1031
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-1031
Mailing Address - Country:US
Mailing Address - Phone:661-822-4402
Mailing Address - Fax:
Practice Address - Street 1:CCI
Practice Address - Street 2:24900 END OF HWY 202
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561
Practice Address - Country:US
Practice Address - Phone:661-822-4402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH73450Medicare UPIN