MEDICARE: NOEMI ORTEGON

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	251S00000X	Community/Behavioral Health Agency
2	171W00000X	Contractor

General Provider Information

NPI Number	:	1770954091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEMI ORTEGON

Provider Business Mailing Address
First Line	:	246 STOLNET ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-2503
Country	:	US
Telephone Number	:	210-459-9464
Fax Number	:

Provider Business Practice Location Address
First Line	:	246 STOLNET ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-2503
Country	:	US
Telephone Number	:	210-459-9464
Fax Number	:

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

Provider Enumeration Date	:	10/13/2015
Last Update Date	:	10/21/2016

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Directions to “ NOEMI ORTEGON ” Practice Location

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