Provider Demographics
NPI:1982694824
Name:ORTEGA, RICARDO J (MD)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:J
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 1:5519 RABADI CASTLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1412
Mailing Address - Country:US
Mailing Address - Phone:505-833-5091
Mailing Address - Fax:505-352-6857
Practice Address - Street 1:5519 RABADI CASTLE AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1412
Practice Address - Country:US
Practice Address - Phone:505-833-5091
Practice Address - Fax:505-352-6857
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81-280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81-280OtherSTATE MEDICAL LICENSE #
NMCS00008264OtherNM STATE PHARMACY #
NM400521255OtherMEDICARE PROVIDER #
NMAO1187889OtherDEA
NM344606503Medicare PIN
NMAO1187889OtherDEA