Healthcare Provider Details

I. General information

NPI: 1104897248
Provider Name (Legal Business Name): LEANDRITA F ORTEGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 10TH ST SUITE A
ALAMOGORDO NM
88310-5012
US

IV. Provider business mailing address

250 1ST ST
ALAMOGORDO NM
88310-6517
US

V. Phone/Fax

Practice location:
  • Phone: 575-434-5195
  • Fax: 575-434-5790
Mailing address:
  • Phone: 575-434-5195
  • Fax: 575-434-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23586
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2012-0047
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: