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General NPI Number Information
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NPI Number | 1366879108
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Entity Type | Individual
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Provider Name | JONATHAN ORTEGA PA
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Gender | Male
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Dates
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Enumeration Date | 10/10/2013
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 68 HARRIS RD
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City | HARRIS
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State | NY
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Zip | 12742-5030
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Country | US
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Telephone | 800-893-9698
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CORPORATE BLVD SUITE 201
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City | LAFAYETTE
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State | LA
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Zip | 70508-3870
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 016976
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License Number State | NY
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