Provider Demographics
NPI:1780061481
Name:ORTEGA, BIANCA GISELLE (PA-C)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:GISELLE
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:PA-C
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 157
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88211-0157
Mailing Address - Country:US
Mailing Address - Phone:575-746-3616
Mailing Address - Fax:575-748-2544
Practice Address - Street 1:612 N 13TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1112
Practice Address - Country:US
Practice Address - Phone:575-746-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2015-0010363A00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant