MEDICARE: JOSHUA ORTEGO

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
2	207N00000X	Dermatology Physician	T4111	MS

General Provider Information

NPI Number	:	1518420827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA ORTEGO

Provider Business Mailing Address
First Line	:	5804 OLDE OAKVIEW
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-8732
Country	:	US
Telephone Number	:	985-249-4899
Fax Number	:

Provider Business Practice Location Address
First Line	:	6510 HIGHWAY 90 STE C
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-5015
Country	:	US
Telephone Number	:	228-372-8559
Fax Number	:

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

Provider Enumeration Date	:	04/12/2019
Last Update Date	:	06/06/2023

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Directions to “ JOSHUA ORTEGO ” Practice Location

Language	Start Address	Practice Location

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