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General NPI Number Information
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NPI Number | 1659043925
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Entity Type | Individual
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Provider Name | GINNA MARIEL LORA ORTEGA PA
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Gender | Female
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 2626 HALPERIN AVE
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City | BRONX
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State | NY
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Zip | 10461-2631
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Country | US
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Telephone | 718-583-7736
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Fax | 718-537-6180
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Provider Business Mailing Address
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Address Line | 2626 HALPERIN AVE
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City | BRONX
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State | NY
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Zip | 10461-2631
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Country | US
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Telephone | 718-618-0461
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Fax | 718-537-6180
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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 | PA9115070
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License Number State | FL
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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 | 029359
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License Number State | NY
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