Provider Demographics
NPI:1770609042
Name:R & L ORTEGA PLLC
Entity type:Organization
Organization Name:R & L ORTEGA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEANDRITA
Authorized Official - Middle Name:FLORES
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-272-0922
Mailing Address - Street 1:520 N MONTE VISTA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4674
Mailing Address - Country:US
Mailing Address - Phone:580-272-0922
Mailing Address - Fax:580-272-0811
Practice Address - Street 1:520 N MONTE VISTA ST
Practice Address - Street 2:SUITE A
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4674
Practice Address - Country:US
Practice Address - Phone:580-272-0922
Practice Address - Fax:580-272-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23586261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200102180AMedicaid
OK200102180AMedicaid