MEDICARE: ELISA MALENNY ORTEGA-GARCIA RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-21-164808	IN

General Provider Information

NPI Number	:	1073194312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA MALENNY ORTEGA-GARCIA RBT

Provider Business Mailing Address
First Line	:	8063 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6001
Country	:	US
Telephone Number	:	845-826-3721
Fax Number	:

Provider Business Practice Location Address
First Line	:	8063 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6001
Country	:	US
Telephone Number	:	317-648-9509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	09/09/2025

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