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General NPI Number Information
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NPI Number | 1366028748
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Entity Type | Individual
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Provider Name | OMAR ANTONIO ANDINO-ORTEGA MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 1142 E SOUTHERN AVE STE C101
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City | MESA
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State | AZ
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Zip | 85204-5055
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Country | US
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Telephone | 480-821-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 3150 E RAY RD APT 553
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City | GILBERT
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State | AZ
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Zip | 85296-1691
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Country | US
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Telephone | 787-466-1320
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 75506
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License Number State | AZ
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