MEDICARE: JUAN ANTONIO ORTEGA-MORA MD PA

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	208D00000X	General Practice Physician	E3593	TX
2	208000000X	Pediatrics Physician	E3593	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821232968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUAN ANTONIO ORTEGA-MORA MD PA

Provider Business Mailing Address
First Line	:	3313 ORLANDO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-4854
Country	:	US
Telephone Number	:	713-699-9177
Fax Number	:

Provider Business Practice Location Address
First Line	:	3313 ORLANDO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-4854
Country	:	US
Telephone Number	:	713-699-9177
Fax Number	:

Authorized Official
Title or Position	:	BILLING ADMINISTRATOR
Name	:	MR. JUAN CARLOS ORTEGA JR.
Credential	:
Telephone Number	:	281-740-0856

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	04/20/2009

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