Healthcare Provider Details

I. General information

NPI: 1356896203
Provider Name (Legal Business Name): ASHLEY ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CLINTON CT
BELEN NM
87002-9508
US

IV. Provider business mailing address

201 CLINTON CT
BELEN NM
87002-9508
US

V. Phone/Fax

Practice location:
  • Phone: 505-377-3540
  • Fax:
Mailing address:
  • Phone: 505-377-3540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number512153305
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: