1386618858 NPI number — JOANNA ORTEGA ORTIZ RN, PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386618858 NPI number — JOANNA ORTEGA ORTIZ RN, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ
Provider First Name:
JOANNA
Provider Middle Name:
ORTEGA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEUNG
Provider Other First Name:
JOANNA
Provider Other Middle Name:
ORTEGA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386618858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7700 WISCONSIN AVE
Provider Second Line Business Mailing Address:
7TH FLOOR-FEDERAL OCCUPATIONAL HEALTH MEDICAL EMPLOYABI
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-583-4328
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 WISCONSIN AVE
Provider Second Line Business Practice Location Address:
7TH FLOOR-FEDERAL OCCUPATIONAL HEALTH MEDICAL EMPLOYABI
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-583-4328
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  0001149229 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 006095 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: C0002889 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 0110001370 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 006095 . This is a "PHYSICIAN ASSISTANT" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: C0002889 . This is a "PHYSICIAN ASSISTANT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0001149229 . This is a "NURSING" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0110001370 . This is a "PHYSICIAN ASSISTANT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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