Healthcare Provider Details

I. General information

NPI: 1386618858
Provider Name (Legal Business Name): JOANNA ORTEGA ORTIZ RN, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA ORTEGA LEUNG RN, PA-C

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 WISCONSIN AVE 7TH FLOOR-FEDERAL OCCUPATIONAL HEALTH MEDICAL EMPLOYABI
BETHESDA MD
20857
US

IV. Provider business mailing address

7700 WISCONSIN AVE 7TH FLOOR-FEDERAL OCCUPATIONAL HEALTH MEDICAL EMPLOYABI
BETHESDA MD
20857
US

V. Phone/Fax

Practice location:
  • Phone: 757-583-4328
  • Fax:
Mailing address:
  • Phone: 757-583-4328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001149229
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006095
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002889
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001370
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: