Healthcare Provider Details

I. General information

NPI: 1528012838
Provider Name (Legal Business Name): MIGUEL A ORTEGA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 AVE LUIS MUNOZ RIVERA S
CAYEY PR
00736-4704
US

IV. Provider business mailing address

107 AVE LUIS MUNOZ RIVERA S
CAYEY PR
00736-4704
US

V. Phone/Fax

Practice location:
  • Phone: 787-738-2578
  • Fax:
Mailing address:
  • Phone: 787-738-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3241
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier063454
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerCRUZ AZUL
# 2
Identifier947830R
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerTRIPLE SSS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: