MEDICARE: RODRIGO ORTEGA DDS

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	1223G0001X	General Practice Dentistry	41504	CA

General Provider Information

NPI Number	:	1619188638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODRIGO ORTEGA DDS

Provider Business Mailing Address
First Line	:	312 N. SOTO ST.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033
Country	:	US
Telephone Number	:	323-263-3918
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 N SOTO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1815
Country	:	US
Telephone Number	:	323-263-3918
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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