MEDICARE: STEPHANIE ORTEGA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1336578392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ORTEGA

Provider Business Mailing Address
First Line	:	4610 SW 163RD PATH
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-3852
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4610 SW 163RD PATH
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-3852
Country	:	US
Telephone Number	:	786-556-5127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2013
Last Update Date	:	11/10/2013

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Directions to “ STEPHANIE ORTEGA ” Practice Location

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