Healthcare Provider Details

I. General information

NPI: 1780971853
Provider Name (Legal Business Name): CAMILO ANDRES ORTEGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CAMILO ANDRES ORTEGA PARRA MD

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5495 ARAPAHOE AVE STE 100
BOULDER CO
80303-1224
US

IV. Provider business mailing address

PO BOX 9049
BOULDER CO
80301-9049
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-4250
  • Fax: 303-440-9629
Mailing address:
  • Phone: 303-415-4101
  • Fax: 303-415-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number201401579
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0073829
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: