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General NPI Number Information
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NPI Number | 1710988100
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Entity Type | Individual
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Provider Name | SHAUN MICHAEL ORTEGA P.A.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 6701 ROCKSIDE RD SUITE 103
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2358
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Country | US
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Telephone | 216-369-2800
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Fax | 216-369-0456
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Provider Business Mailing Address
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Address Line | 7580 NORTHCLIFF AVE SUITE 500
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City | BROOKLYN
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State | OH
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Zip | 44144-3270
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Country | US
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Telephone | 216-472-2741
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Fax | 216-472-2739
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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 | 50001422
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License Number State | OH
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