Provider Demographics
NPI:1053497784
Name:ORTA, PEDRO ALBERTO (DC)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:ALBERTO
Last Name:ORTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6998 N US HIGHWAY 27
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482
Mailing Address - Country:US
Mailing Address - Phone:352-732-9355
Mailing Address - Fax:352-732-9356
Practice Address - Street 1:6998 N US HIGHWAY 27
Practice Address - Street 2:SUITE 110
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482
Practice Address - Country:US
Practice Address - Phone:352-732-9355
Practice Address - Fax:352-732-9356
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U53303Medicare UPIN
FL55217YMedicare ID - Type Unspecified