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General NPI Number Information
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NPI Number | 1104897248
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Entity Type | Individual
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Provider Name | LEANDRITA F ORTEGA MD
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Gender | Female
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 1401 10TH ST SUITE A
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City | ALAMOGORDO
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State | NM
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Zip | 88310-5012
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Country | US
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Telephone | 575-434-5195
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Fax | 575-434-5790
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Provider Business Mailing Address
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Address Line | 250 1ST ST
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6517
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Country | US
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Telephone | 575-434-5195
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Fax | 575-434-5790
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23586
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2012-0047
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License Number State | NM
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