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General NPI Number Information
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NPI Number | 1194499244
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Entity Type | Individual
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Provider Name | OTHONIELLA ORTEGA MD
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Gender | Female
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Dates
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Enumeration Date | 08/03/2021
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | CALLE ANTERA MOTA PLAZA MILANO 3ER NIVEL
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City | PUERTO PLATA
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State | PUERTO PLATA
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Zip | 56000
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Country | DO
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Telephone | 829-889-9858
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Fax |
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Provider Business Mailing Address
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Address Line | 2607 JEROME AVE APT 32
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City | BRONX
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State | NY
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Zip | 10468-4316
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Country | US
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Telephone |
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Fax |
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 362-15
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License Number State | NY
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