Provider Demographics
NPI:1104897248
Name:ORTEGA, LEANDRITA F (MD)
Entity type:Individual
Prefix:
First Name:LEANDRITA
Middle Name:F
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6517
Mailing Address - Country:US
Mailing Address - Phone:575-434-5195
Mailing Address - Fax:575-434-5790
Practice Address - Street 1:1401 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5012
Practice Address - Country:US
Practice Address - Phone:575-434-5195
Practice Address - Fax:575-434-5790
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23586207Q00000X
NMMD2012-0047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79805361Medicaid
OK200046270AMedicaid
248507604Medicare ID - Type Unspecified
NM79805361Medicaid
NM360275YLNYMedicare PIN