Healthcare Provider Details

I. General information

NPI: 1164661724
Provider Name (Legal Business Name): LILIA B. ORTEGA STA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 MONTANA AVE STE H
EL PASO TX
79925-2155
US

IV. Provider business mailing address

12629 TIERRA PERLA CT
EL PASO TX
79938-4830
US

V. Phone/Fax

Practice location:
  • Phone: 915-838-7604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number34828
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: