Provider Demographics
NPI:1912123167
Name:LAURO I. ORTEGA, MD, PA
Entity Type:Organization
Organization Name:LAURO I. ORTEGA, MD, PA
Other - Org Name:DWAYNE M. ABOUD, MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-845-4024
Mailing Address - Street 1:154 N FESTIVAL DR STE G
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6265
Mailing Address - Country:US
Mailing Address - Phone:915-845-4024
Mailing Address - Fax:915-845-4019
Practice Address - Street 1:154 N FESTIVAL DR STE G
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6265
Practice Address - Country:US
Practice Address - Phone:915-845-4024
Practice Address - Fax:915-845-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000T60W8Medicaid
TXZ000T60W8Medicaid