Healthcare Provider Details

I. General information

NPI: 1568137172
Provider Name (Legal Business Name): MELISSA ORTEGA RN, BSN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W ALAMEDA ST
SANTA FE NM
87501-1681
US

IV. Provider business mailing address

PO BOX 6880
SANTA FE NM
87502-6880
US

V. Phone/Fax

Practice location:
  • Phone: 505-955-9454
  • Fax: 808-982-6298
Mailing address:
  • Phone: 505-955-9454
  • Fax: 505-216-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-84679
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN-84679
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: