=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821232968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUAN ANTONIO ORTEGA-MORA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2009
-----------------------------------------------------
Last Update Date | 04/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3313 ORLANDO ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77093-4854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-699-9177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3313 ORLANDO ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77093-4854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-699-9177
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING ADMINISTRATOR
-----------------------------------------------------
Name | MR. JUAN CARLOS ORTEGA JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-740-0856
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | E3593
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | E3593
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------