Healthcare Provider Details

I. General information

NPI: 1831296904
Provider Name (Legal Business Name): LUIS CARLOS ORTEGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/04/2023
Certification Date: 02/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S TONOPAH DR
LAS VEGAS NV
89106-4029
US

IV. Provider business mailing address

620 S TONOPAH DR
LAS VEGAS NV
89106-4029
US

V. Phone/Fax

Practice location:
  • Phone: 702-413-1391
  • Fax:
Mailing address:
  • Phone: 702-413-1391
  • Fax: 702-413-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number6969
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: