Healthcare Provider Details

I. General information

NPI: 1740107309
Provider Name (Legal Business Name): RUBY LOPEZ ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 UTAH AVE, BULDING 744
FORT POLK LA
71459
US

IV. Provider business mailing address

7600 UTAH AVE, BULDING 744
FORT POLK LA
71459
US

V. Phone/Fax

Practice location:
  • Phone: 318-446-8319
  • Fax:
Mailing address:
  • Phone: 318-445-6443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: