MEDICARE: AZUCENA ORTEGA-MADANI

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	AP123174	TX
2	363LF0000X	Family Nurse Practitioner	AP123174	TX

General Provider Information

NPI Number	:	1376944488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZUCENA ORTEGA-MADANI

Provider Business Mailing Address
First Line	:	6221 VIA AVENTURA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1818
Country	:	US
Telephone Number	:	915-833-0837
Fax Number	:

Provider Business Practice Location Address
First Line	:	6221 VIA AVENTURA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1818
Country	:	US
Telephone Number	:	915-833-0837
Fax Number	:

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

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	08/02/2019

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