Healthcare Provider Details

I. General information

NPI: 1740274638
Provider Name (Legal Business Name): ROGELIO GUILLERMO ORTEGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 BROWN RD
IMPERIAL CA
92251
US

IV. Provider business mailing address

PO BOX 731
IMPERIAL CA
92251-0731
US

V. Phone/Fax

Practice location:
  • Phone: 760-337-7900
  • Fax:
Mailing address:
  • Phone: 760-337-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA79932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: