Healthcare Provider Details

I. General information

NPI: 1710120217
Provider Name (Legal Business Name): OMAR O ORTEGA R.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLE BETANCES EDIFICIO ROSSY
CIALES PR
00638-3200
US

IV. Provider business mailing address

PO BOX 275
CIALES PR
00638-0275
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-0446
  • Fax:
Mailing address:
  • Phone: 787-438-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number2194
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2471R0002X
TaxonomyRadiation Therapy Radiologic Technologist
License Number#87
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: