MEDICARE: DR. ROBERT WAYNE ORTEGO M.D.

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	207Q00000X	Family Medicine Physician	CFE30230	CA

General Provider Information

NPI Number	:	1528406766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WAYNE ORTEGO M.D.

Provider Business Mailing Address
First Line	:	5455 SYLMAR AVE.
Second Line	:	SUITE 2302
City	:	LOS ANGELES
State	:	CA
Zip	:	91401-5124
Country	:	US
Telephone Number	:	818-786-0753
Fax Number	:

Provider Business Practice Location Address
First Line	:	5455 SYLMAR AVE.
Second Line	:	SUITE 2302
City	:	LOS ANGELES
State	:	CA
Zip	:	91401-5124
Country	:	US
Telephone Number	:	818-786-0753
Fax Number	:

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

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	06/10/2013

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