Provider Demographics
NPI:1194499244
Name:ORTEGA, OTHONIELLA (MD)
Entity type:Individual
Prefix:
First Name:OTHONIELLA
Middle Name:
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 1:2607 JEROME AVE APT 32
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-4316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE ANTERA MOTA PLAZA MILANO 3ER NIVEL
Practice Address - Street 2:
Practice Address - City:PUERTO PLATA
Practice Address - State:PUERTO PLATA
Practice Address - Zip Code:56000
Practice Address - Country:DO
Practice Address - Phone:829-889-9858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY362-15261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care