Provider Demographics
NPI:1386167575
Name:ORTA IGLESIAS, ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:ORTA IGLESIAS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14996 SW 108TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2507
Mailing Address - Country:US
Mailing Address - Phone:786-718-5454
Mailing Address - Fax:
Practice Address - Street 1:14601 SW 104TH ST STE 14601
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2905
Practice Address - Country:US
Practice Address - Phone:786-275-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19729207Q00000X
FLACN967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty