MEDICARE: ORTEGA-RODRIGUEZ MEDICAL SERVICES , INC

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	208000000X	Pediatrics Physician	0101258599	VA

General Provider Information

NPI Number	:	1487038915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTEGA-RODRIGUEZ MEDICAL SERVICES , INC

Provider Business Mailing Address
First Line	:	11213 KINGFISHER TER
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-3148
Country	:	US
Telephone Number	:	954-805-4121
Fax Number	:

Provider Business Practice Location Address
First Line	:	3914 MEADOWDALE BLVD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-5547
Country	:	US
Telephone Number	:	954-805-4121
Fax Number	:

Authorized Official
Title or Position	:	PEDIATRICIAN
Name	:	DR. PAOLA ANDREA ORTEGA RODRIGUEZ
Credential	:	M.D
Telephone Number	:	954-805-4121

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	07/14/2015

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