Provider Demographics
NPI:1285844837
Name:ORTEGA, CHARLES E (PAC, MPAS)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:ORTEGA
Suffix:
Gender:
Credentials:PAC, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16901 DALLAS PKWY STE 206
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5214
Mailing Address - Country:US
Mailing Address - Phone:214-233-3094
Mailing Address - Fax:214-241-1167
Practice Address - Street 1:16901 DALLAS PKWY STE 206
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5214
Practice Address - Country:US
Practice Address - Phone:214-233-3094
Practice Address - Fax:214-241-1167
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
TXPA02353363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP19402OtherMEDICAL LICENSE
TXPA02353OtherLICENSE