Healthcare Provider Details

I. General information

NPI: 1811079635
Provider Name (Legal Business Name): VINCENT J ORTEGA L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3492 NORTHPOINTE DR
LAS CRUCES NM
88012-8530
US

IV. Provider business mailing address

3492 NORTHPOINTE DR
LAS CRUCES NM
88012-8530
US

V. Phone/Fax

Practice location:
  • Phone: 505-382-1741
  • Fax: 505-382-1741
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4556
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: