MEDICARE: AUSTIN PAUL ORTEGA

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1841735131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN PAUL ORTEGA

Provider Business Mailing Address
First Line	:	6601 BLUEWATER RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73165-9651
Country	:	US
Telephone Number	:	405-517-4840
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 BLUEWATER RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73165-9651
Country	:	US
Telephone Number	:	405-517-4840
Fax Number	:

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

Provider Enumeration Date	:	12/22/2016
Last Update Date	:	12/22/2016

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Directions to “ AUSTIN PAUL ORTEGA ” Practice Location

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