Healthcare Provider Details

I. General information

NPI: 1538394879
Provider Name (Legal Business Name): LORENA D ORTIZ ALBA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PADRE DE LAS CASA #301 ESQ. CON MATAMOROS
PIEDRAS NEGRAS COAHUILA
26000
MX

IV. Provider business mailing address

1437 RAINTREE DR
EAGLE PASS TX
78852
US

V. Phone/Fax

Practice location:
  • Phone: 830-325-9427
  • Fax: 011528787824577
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2783524
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: