Provider Demographics
NPI:1689352767
Name:ORTEGA, ORESTES ROMAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ORESTES
Middle Name:ROMAN
Last Name:ORTEGA
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2031 W DIXON ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-4416
Mailing Address - Country:US
Mailing Address - Phone:602-481-7286
Mailing Address - Fax:
Practice Address - Street 1:3130 E BASELINE RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7290
Practice Address - Country:US
Practice Address - Phone:480-497-5933
Practice Address - Fax:480-497-5934
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ245660163WH0200X
AZTEMP245660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health