1699854067 NPI number — MR. MANUEL ORTEGA M.D.

Table of content: MR. MANUEL ORTEGA M.D. (NPI 1699854067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699854067 NPI number — MR. MANUEL ORTEGA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTEGA
Provider First Name:
MANUEL
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ORTEGA ELIAS
Provider Other First Name:
MANUEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699854067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5955 PONCE DE LEON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33146-2423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-662-8668
Provider Business Mailing Address Fax Number:
305-662-3723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5955 PONCE DE LEON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAL GABLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33146-2423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-662-8668
Provider Business Practice Location Address Fax Number:
305-662-3723
Provider Enumeration Date:
11/04/2006

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: 2080N0001X , with the licence number:  ME 61620 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: ME061620 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 370511100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".