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General NPI Number Information
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NPI Number | 1215363833
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Entity Type | Individual
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Provider Name | LUIS D ORTEGA PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 4001 TIETON DR
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City | YAKIMA
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State | WA
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Zip | 98908-3345
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Country | US
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Telephone | 509-410-0746
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Fax | 509-410-0749
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Provider Business Mailing Address
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Address Line | 1211 N 16TH AVE
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City | YAKIMA
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State | WA
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Zip | 98902-1347
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Country | US
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Telephone | 509-454-8888
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Fax | 509-453-0061
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA60325052
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License Number State | WA
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