Healthcare Provider Details

I. General information

NPI: 1679049266
Provider Name (Legal Business Name): MEGHAN THERESE ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MEDICAL ARTS AVE NE BLDG 3
ALBUQUERQUE NM
87102-2722
US

IV. Provider business mailing address

PO BOX 1180
OHKAY OWINGEH NM
87566-1180
US

V. Phone/Fax

Practice location:
  • Phone: 505-933-4639
  • Fax:
Mailing address:
  • Phone: 505-525-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: