Healthcare Provider Details

I. General information

NPI: 1750644894
Provider Name (Legal Business Name): GUSTAVO ORTEGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 E 5TH ST STE 101
TUCSON AZ
85711-2415
US

IV. Provider business mailing address

4801 E BROADWAY BLVD STE 251
TUCSON AZ
85711-2700
US

V. Phone/Fax

Practice location:
  • Phone: 520-886-4181
  • Fax: 520-721-7536
Mailing address:
  • Phone: 520-382-1205
  • Fax: 520-795-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50498
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50498
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: