Provider Demographics
NPI:1831185453
Name:ORTEGA, YVONNE C (MD)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:C
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10561 JEFFREYS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4267
Mailing Address - Country:US
Mailing Address - Phone:703-405-6333
Mailing Address - Fax:
Practice Address - Street 1:10561 JEFFREYS ST STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4267
Practice Address - Country:US
Practice Address - Phone:703-405-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019694207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051010198OtherBCBS
NV100510604Medicaid
AL051031445Medicaid
AL000031445Medicaid
AL5725112OtherAETNA
AL000010198Medicaid
AL051031445OtherBCBS
AL009935863Medicaid
AL051031445Medicaid
AL000010198Medicaid
NVV103166Medicare PIN
AL051031445OtherBCBS
AL930076416Medicare PIN
AL051031445Medicare PIN