Provider Demographics
NPI:1285900274
Name:ORTEGA, TRIXIE MICHEA
Entity type:Individual
Prefix:MRS
First Name:TRIXIE
Middle Name:MICHEA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 GALLERIA CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2346
Mailing Address - Country:US
Mailing Address - Phone:205-909-1038
Mailing Address - Fax:205-909-1059
Practice Address - Street 1:3650 GALLERIA CIR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2346
Practice Address - Country:US
Practice Address - Phone:205-909-1038
Practice Address - Fax:205-909-1059
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-24
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist