Healthcare Provider Details

I. General information

NPI: 1548938517
Provider Name (Legal Business Name): ALONDRA ORTEGA DE CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADOVIO HERRERA 2348
NUEVO LAREDO TAMPS
88040
MX

IV. Provider business mailing address

MADOVIO HERRERA 2348
NUEVO LAREDO TAMPS
88040
MX

V. Phone/Fax

Practice location:
  • Phone: 956-949-6574
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number09055532
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: